Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 35051765S | OH |
NPI | 1184624231 |
---|---|
Provider Name | Ann Smith |
First Address | Toledo, OH 43623-4231 |
Second Address | Toledo, OH 43623-4231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 21/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0671125 | (05) | OH |
A16740 | (02) |