Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | TRN29212 | FL |
NPI | 1003349879 |
---|---|
Provider Name | Dr. Autumn Rae Smith |
First Address | Pensacola, FL 32504-5708 |
Second Address | Pensacola, FL 32504-5708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2017 |
Last Update Date | 15/05/2020 |