Basic Information
| Provider Information | |||||||||
| NPI: | 1922053412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMOLA | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | RAY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 E ARIZONA AVE | ||||||||
| Address2: | |||||||||
| City: | SWEETWATER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795567119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3252358641 | ||||||||
| FaxNumber: | 3252355925 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 E ARIZONA AVE | ||||||||
| Address2: | |||||||||
| City: | SWEETWATER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795567119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3252358641 | ||||||||
| FaxNumber: | 3252355925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 02/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | H8416 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | H8416 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1922053412 | 01 | TX | NPI | OTHER |