Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 14257 | TX |
NPI | 1861022949 |
---|---|
Provider Name | Constance Mae Smith |
First Address | Austin, TX 78729-4762 |
Second Address | Round Rock, TX 78664-4680 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2020 |
Last Update Date | 17/01/2020 |