Jerry Randolph Smith MD

NPI 1003989708 - Family Medicine - 207Q00000X

NPI Details
NPI 1003989708
Gender Male
Enumeration Date 11/17/2006
Last Updated 07/25/2012
Entity Type Individual
Active Over 10 years ago
Practice Location
3015 WILSON AVE
PARK DUVALLE CNC
LOUISVILLE KY, 40211, US
Phone (502) 774-4401
Fax (502) 772-4783
Business Location
3015 WILSON AVE
LOUISVILLE KY, 40211-1961, US
Phone (502) 774-4401
Fax (502) 772-4785
Toxanomy
Taxonomy Code 207Q00000X
License State Kentucky
License Number 18109
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According to our database, Dr. Jerry Randolph Smith MD NPI is 1003989708, taxonomy code is 207Q00000X and license number is 18109, license state is located at Kentucky. Jerry Randolph Smith MD physically located at 3015 Wilson Ave, Louisville KY, 40211. NPI Number Jerry Randolph Smith MD has the Individual type.

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1003989708 NPI number is provided on an as is basis without warranty of any kind. 1003989708 is maintained by the National Plan & Provider Enumeration System. The contents of Jerry Randolph Smith MD are for informational purposes only.