Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MDH3177 | TX |
NPI | 1699779652 |
---|---|
Provider Name | Dr. Gary L Smith |
First Address | Corpus Christi, TX 78466-0170 |
Second Address | Corpus Christi, TX 78411-4670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 15/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120650004 | (05) | TX |
84530Y | BCBS OF TX PROVIDER NO (01) | TX |
D79656 | (02) | TX |