Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO60217485 | WA |
NPI | 1003119405 |
---|---|
Provider Name | Dr. Jarrod Alexander Smith |
First Address | Everett, WA 98201-4137 |
Second Address | Everett, WA 98201-4137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2010 |
Last Update Date | 25/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0279819 | WASHINGTON STATE DEPT OF LABOR & INDUSTRIES (01) | WA |
1003119405 | (05) | WA |
6037215 | CIGNA (01) |