Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | E-11669 | AR |
NPI | 1023540655 |
---|---|
Provider Name | Aaron M Smith |
First Address | Little Rock, AR 72206-6014 |
Second Address | Arkadelphia, AR 71923-8319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2017 |
Last Update Date | 09/05/2021 |