Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 5412561-1205 | UT |
N | 2080P0203X | Pediatric Critical Care Doctor | 5412561-1205 | UT |
NPI | 1033111810 |
---|---|
Provider Name | Dr. Andrew Gerald Smith |
First Address | Salt Lake City, UT 84141-3021 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 22/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807219800 | (05) | ID |