Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | F0313 | TX |
NPI | 1558305490 |
---|---|
Provider Name | Dr. Ellen Blair Smith |
First Address | Dallas, TX 75391-1230 |
Second Address | Austin, TX 78705-1165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 15/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0811853-01 | (05) | TX |
128726003 | (05) | TX |
128726006 | (05) | TX |
128726007 | (05) | TX |
830004600 | RAILROAD MEDICARE NUMBER (01) | TX |
8BP361 | BCBS OF TX (01) | TX |
C21932 | (02) | TX |