Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35071076 | OH |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 35071076S | OH |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35071076S | OH |
NPI | 1184665408 |
---|---|
Provider Name | Dr. Ethel Ea Smith |
First Address | Independence, OH 44131-5032 |
Second Address | Cleveland, OH 44195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 22/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
283465 | (05) | OH |
G50595 | (02) | OH |