JACOB KELLY SMITH

PORTLAND, OR
NPI1508457300
Other NameJAKE SMITH
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
(Licence: OR  PG215454)
Enumeration Date2021-02-03
Last Update Date2023-06-18
Business Address
JACOB KELLY SMITH MD
9205 SW BARNES RD
PORTLAND, OR 97225-6603
Phone number: 503-216-2621
Mailing Address
JACOB KELLY SMITH MD
PO BOX 3158
PORTLAND, OR 97208-3158
Phone number: 503-215-6494