Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G2620 | TX |
NPI | 1144217902 |
---|---|
Provider Name | Dr. Carolyn Ann Smith |
First Address | Dallas, TX 75243-6235 |
Second Address | Dallas, TX 75243-6235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 25/09/2007 |