Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0031 | NV |
NPI | 1255391579 |
---|---|
Provider Name | Dr. Carl Bert Smith |
First Address | Las Vegas, NV 89121-4264 |
Second Address | Las Vegas, NV 89121-4264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 14/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002102887 | (05) | NV |
480011132 | RAILROAD MEDICARE ID # (01) | NV |
T67363 | (02) | NV |