Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | J7378 | TX |
NPI | 1023002375 |
---|---|
Provider Name | David B Smith |
First Address | Beaumont, TX 77702-1501 |
Second Address | Beaumont, TX 77702-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131241505 | (05) | TX |
160041091 | RAILROAD MEDICARE (01) | TX |
G05046 | (02) |