Provider Demographics
NPI:1861961153
Name:SMITH, JEFFERY MICHAEL (PA)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0307
Mailing Address - Country:US
Mailing Address - Phone:801-294-6907
Mailing Address - Fax:801-294-6917
Practice Address - Street 1:441 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84104-3539
Practice Address - Country:US
Practice Address - Phone:801-973-2588
Practice Address - Fax:801-973-6985
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2021-11-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant