Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 8105 | NH |
NPI | 1003994476 |
---|---|
Provider Name | Dr. C Christopher Smith |
First Address | Brewer, ME 04412-1005 |
Second Address | Bangor, ME 04401-3083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B65417 | (02) | NH |