Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 14078 | TN |
NPI | 1124175542 |
---|---|
Provider Name | David L Smith |
First Address | Memphis, TN 38128-5723 |
Second Address | Memphis, TN 38128-5723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B04490 | (02) | TN |