Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | E-10568 | AR |
N | 208200000X | Surgeon | 208600000X | AR |
N | 208600000X | Surgeon | 208600000X | AR |
NPI | 1306163779 |
---|---|
Provider Name | Adam Ryan Smith |
First Address | Little Rock, AR 72204-1720 |
Second Address | Little Rock, AR 72204-1720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 03/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
581944YQCR | MEDICARE PTAN (01) | AR |