Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A-2327-20 | NM |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 05-43138 | KS |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | DO189582 | OR |
NPI | 1093153819 |
---|---|
Provider Name | Dr. Heidi J Smith |
First Address | Manhattan, KS 66502-2750 |
Second Address | Manhattan, KS 66502-2750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 26/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A-2327-20 | NEW MEXICO LICENSE (01) | NM |