Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 4518 | TX |
NPI | 1316273329 |
---|---|
Provider Name | Cecil Paul Smith |
First Address | Dallas, TX 75234-7328 |
Second Address | Dallas, TX 75234-7328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2009 |
Last Update Date | 26/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L53B | BLUE CROSS BLUE SHIELD (01) | TX |