Smith, Jeffery M

Smith, Jeffery M is an sole proprietor health care provider with primary practice located at 304 W Hay St Suite 215, Decatur IL 62526-6328. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hand Surgery, which is considered as his primary health care specialty. Smith, Jeffery M can be contacted via phone (247) 875-4263.

Contact Information

Primary practice address
304 W Hay St Suite 215 Decatur IL 62526-6328
Phone: (247) 875-4263
Fax: (217) 872-5481
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hand Surgery 207XS0106X 0360982761 Illinois

Profile Details

NPI number 1104841188
LBN Legal business name Smith, Jeffery M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 12th, 2006
Last updated Feb 16th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104841188 NPPES
Illinois Other 05832033 BLUE CROSS BLUE SHIELD
Illinois Other 388802 BLUE CROSS BLUE SHIELD
Illinois Other P00048412 BLUE CROSS BLUE SHIELD
Illinois MEDICAID 0360982761 BLUE CROSS BLUE SHIELD

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