MR. Jacob Smith, PA-C, ATC
NPI #1548675945 in Bloomington, Illinois
Provider Information
- NPI Number
- 1548675945
- Entity Type
- Individual
- Name
- MR. Jacob Smith, PA-C, ATC
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Physician Assistant
- Credential
- PA-C, ATC
- Enumeration Date
- Jun 24, 2014
- Last Updated
- Mar 30, 2022
Practice Location
- Address
- 1111 TRINITY LN STE 111
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61704-8112
- Phone
- (309) 663-6461
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant - Medical — Medical |
| Physician Assistant |
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