Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 29799 | MN |
NPI | 1144212572 |
---|---|
Provider Name | Andrew Donald Smith JR. |
First Address | Austin, MN 55912-2941 |
Second Address | Austin, MN 55912-2941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 24/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
272005100 | (05) | MN |
A03611 | (02) | MN |