Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | C1-0000685 | DE |
Y | 207R00000X | Internist | C1-0000685 | DE |
Y | 111NI0900X | Internist | C1-0000685 | DE |
NPI | 1174873277 |
---|---|
Provider Name | Dr. Charles Mittnacht Smith |
First Address | Santa Fe, NM 87501-2900 |
Second Address | Santa Fe, NM 87501-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2012 |
Last Update Date | 16/09/2012 |