Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 50683 | KY |
N | 207Q00000X | Family Doctor | R3520 | KY |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 50683 | KY |
NPI | 1346669025 |
---|---|
Provider Name | Dr. Gerdie Jean-Smith |
First Address | Port Charlotte, FL 33980-2284 |
Second Address | Port Charlotte, FL 33980-2284 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 27/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100362060 | (05) | KY |
K161440 | MEDICARE (01) | KY |