Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 8771272-1205 | UT |
N | 207R00000X | Internist | 35084855 | OH |
N | 111NI0900X | Internist | 35084855 | OH |
NPI | 1164468955 |
---|---|
Provider Name | Andrew Smith |
First Address | Murray, UT 84107-7377 |
Second Address | Murray, UT 84107-7377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000351769 | ANTHEM (01) | |
0409999 | UNITED (01) | |
283621 | AMERIGROUP (01) | |
659345 | AETNA (01) | |
I21705 | (02) |