Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | G24829 | CA |
NPI | 1568664548 |
---|---|
Provider Name | Dr. Geoffrey Arthur Smith |
First Address | San Diego, CA 92123-2771 |
Second Address | San Diego, CA 92123-2771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G24829 | MEDICAL LISENCE (01) | CA |