MR. JERRY M SMITH JR. IDC
NPI 1659460590
Military Health Care Provider - Independent Duty Corpsman in Port Hueneme, CA

Q: What is Jerry Smith's NPI number?

The NPI number for Jerry Smith is 1659460590. It was assigned to this individual provider in the NPPES registry on October 11, 2006.

Q: What is Jerry Smith's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

Q: When was this NPI record last updated?

The NPPES record for Jerry Smith was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 11, 2006

4643 DOCK RD, BLDG 524, PORT HUENEME, CA 93043(805) 982-2411 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Mr. Jerry M Smith Jr. Idc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JERRY M SMITH JR. IDC (NPI 1659460590) is an individual independent duty corpsman provider in Port Hueneme, California and active in the NPI registry since October 2006.

NPPES Registry Identity

NPI1659460590

Entity TypeIndividualMale

Primary Taxonomy1710I1002X

Provider Legal NameMR. JERRY M SMITH JR.Credential: IDC

Location Address4643 DOCK RD, BLDG 524Port Hueneme, CA 93043-4321

Mailing Address10213 Truett LnSan Diego, CA 92124-3642 · (360) 689-0241

Phone(805) 982-2411

Sole ProprietorNo

Enumeration DateOctober 11, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1659460590 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers

Taxonomy Code1710I1002X

Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.

4643 DOCK RD, Port Hueneme, CA 93043

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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. FERNANDO JUAREZ OTHER

Military Health Care Provider (Independent Duty Corpsman)

4643 DOCK RD, BLDG 524
PORT HUENEME, CA 93043

Ventura County (805) 982-4261

CHRISTOPHER LEE WALKER IDC

Military Health Care Provider (Independent Duty Corpsman)

4643 DOCK RD, BLDG 524
PORT HUENEME, CA 93043

Ventura County (805) 982-2464

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jerry Smith's NPI number?

The NPI number for Jerry Smith is 1659460590. It was assigned to this individual provider in the NPPES registry on October 11, 2006.

Where is Jerry Smith located?

Jerry Smith practices at 4643 Dock Rd Bldg 524, Port Hueneme, CA 93043. The listed phone number is (805) 982-2411.

What is Jerry Smith's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

When was this NPI record last updated?

The NPPES record for Jerry Smith was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.