Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO 60188334 | WA |
NPI | 1427077114 |
---|---|
Provider Name | Dr. Chad G Smith |
First Address | Puyallup, WA 98371-7873 |
Second Address | Puyallup, WA 98371-7873 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 22/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0275410 | (05) | WA |
PO 60188334 | WASHINGTON STATE DEPT OF HEALTH LICENSE (01) | WA |