Provider Demographics
NPI:1861433542
Name:SMITH, HARRY JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:JEROME
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-8136
Mailing Address - Country:US
Mailing Address - Phone:615-746-4711
Mailing Address - Fax:615-296-0952
Practice Address - Street 1:8333 9TH AVE
Practice Address - Street 2:STE: G
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77462-8151
Practice Address - Country:US
Practice Address - Phone:409-729-8088
Practice Address - Fax:409-729-8089
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1065207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE76494OtherUPIN
TX122250702Medicaid
TXTXB138585Medicare PIN