Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | P7987 | TX |
NPI | 1619266772 |
---|---|
Provider Name | Benjamin Carl Smith |
First Address | Dallas, TX 75251-3127 |
Second Address | Dallas, TX 75251-3127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 01/09/2021 |