Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 303381 | NY |
NPI | 1124431275 |
---|---|
Provider Name | Dr. Jesse Ryan Smith |
First Address | Knoxville, TN 37920 |
Second Address | Knoxville, TN 37920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 07/08/2021 |