Jerry M Smith Jr., IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

4643 Dock Rd
BLDG 524
Port Hueneme, CA 93043-4321

Phone

(805) 982-2411

NPI assigned

Oct 11, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Underwater Construction Team Two

  • Military or U.S. Coast Guard Ground Transport Ambulance
  • Port Hueneme, CA
  • NPI 1881952661
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659460590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10213 TRUETT LN",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921243642",
            "telephone_number": "360-689-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4643 DOCK RD",
            "address_2": "BLDG 524",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930434321",
            "telephone_number": "805-982-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JERRY",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kosha Shah, D.D.S.
• Rutu Jignesh Shah, DDS
• Alireza M Sharifzadeh, DDS
• Shoreline ABA
• Silver Strand Optometry Corp
• Michelle Smith
• Steven M Smith, MA, LMFT
• Sol Y Paz Counseling Services Licensed Clinical Social Worker, Inc.
• Eugene Soroka, MD
• Shayne Tyler Stanley

• Independent Duty Corpsman in Port Hueneme, CA
• Providers in Port Hueneme, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.