NPI 1043825698

Jacob Smith

Practitioner Contractor Mesa, AZ

Practice location

Address: 960 W Southern Ave APT 2006, Mesa, AZ 85210-4968
Phone: (602) 488-6496

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X

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Registry record

NPI: 1043825698
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Sep 2020
Record last updated: 10 Sep 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.