Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CO005798 | |
N | 222Z00000X | Podiatrist | CO005798 | |
Y | 224P00000X | Prosthetist | CPO04189 |
NPI | 1245749969 |
---|---|
Provider Name | Cody A Smith |
First Address | Exton, PA 19341-2514 |
Second Address | Charlotte, NC 28211-2886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2017 |
Last Update Date | 23/10/2018 |