Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 2287 | TX |
Y | 213ER0200X | Radiology | 2287 | TX |
NPI | 1578567467 |
---|---|
Provider Name | Dr. Chester Y. Smith |
First Address | Rockdale, TX 76567-1530 |
Second Address | Rockdale, TX 76567-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T15975 | (02) | TX |