Provider Demographics
NPI:1740783836
Name:SMITH, JEREMY A (DO)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DIVISION AVE STE E
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1336
Mailing Address - Country:US
Mailing Address - Phone:210-222-0333
Mailing Address - Fax:726-268-7701
Practice Address - Street 1:600 DIVISION AVE STE E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1336
Practice Address - Country:US
Practice Address - Phone:210-222-0333
Practice Address - Fax:726-268-7701
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205818208D00000X
TXU8824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice