Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD0030597 | WA |
NPI | 1023127727 |
---|---|
Provider Name | Christopher J Smythies |
First Address | Tacoma, WA 98405-4234 |
Second Address | Tacoma, WA 98405-4234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 09/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119610 | L&I (01) | WA |
F62202 | (02) |