Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | D47398 | MD |
NPI | 1174558126 |
---|---|
Provider Name | Bruce Smith |
First Address | Baltimore, MD 21264-4474 |
Second Address | Baltimore, MD 21287-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 19/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
819051800 | (05) | MD |
G09632 | (02) | MD |