Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ML60668496 | WA |
Y | 111NI0900X | Internist | ML60668496 | WA |
NPI | 1003202144 |
---|---|
Provider Name | Brent Smoots |
First Address | Phoenix, AZ 85037-4403 |
Second Address | Peoria, AZ 85382-5820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 01/11/2018 |