Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 1117791 | NY |
Y | 207RH0003X | Hematology & Oncology | 1117792 | NY |
NPI | 1043206519 |
---|---|
Provider Name | Dr. J Robert Smith |
First Address | Syracuse, NY 13210-2298 |
Second Address | Syracuse, NY 13210-2298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00508118 | (05) | NY |
D74922 | (02) |