Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 59986 | MN |
NPI | 1316239361 |
---|---|
Provider Name | David Ian Smith |
First Address | Minneapolis, MN 55455-0130 |
Second Address | Minneapolis, MN 55455-0130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 13/06/2017 |