Individual provider · NPI-1

Dr. Jack Michael Smith, MD

Physical Medicine & Rehabilitation, Pain Medicine · Williamsport, PA

NPI number1346687720
StatusActive
Last updated in NPPESJul 17, 2018

Details

NPI
1346687720
Entity type
Individual (NPI-1)
Name
Dr. Jack Michael Smith
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
May 26, 2013
Last updated
Jul 17, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2081P2900X Physical Medicine & Rehabilitation, Pain MedicineMD463374PAYes

Practice location

1100 Grampian Blvd
Williamsport, PA 17701

Phone 570-326-8457 · Fax 570-320-7989

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900

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