Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | B201400319 | VA |
NPI | 1194232058 |
---|---|
Provider Name | Daren Edward Smith |
First Address | Fredericksburg, VA 22407-8917 |
Second Address | Fredericksburg, VA 22407-6238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2018 |
Last Update Date | 01/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B201400319 | VIRGINIA OFFICE OF EMERGENCY MEDICAL SERVICES (01) | VA |