Smith, Jamie Michelle Wallace

Smith, Jamie Michelle Wallace is an individual health care provider with primary practice located at 107 1St St Ne , Mount Vernon IA 52314-1422. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Smith, Jamie Michelle Wallace can be contacted via phone (319) 361-5875.

Contact Information

Primary practice address
107 1St St Ne Mount Vernon IA 52314-1422
Phone: (319) 361-5875
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X R8646 Iowa
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 39137 Iowa

Profile Details

NPI number 1013144674
LBN Legal business name Smith, Jamie Michelle Wallace
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2009
Last updated Apr 17th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013144674 NPPES
Iowa MEDICAID 1013144674

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