Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | C22040 | DE |
N | 222Z00000X | Podiatrist | C22040 | DE |
Y | 224P00000X | Prosthetist | C22040 | DE |
NPI | 1255768172 |
---|---|
Provider Name | Brian Smith |
First Address | Salisbury, MD 21804-7099 |
Second Address | Salisbury, MD 21804-7099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2013 |
Last Update Date | 11/03/2015 |