Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 0401005040 | VA |
NPI | 1417010430 |
---|---|
Provider Name | Dr. James Henderson Smith Whitney |
First Address | New Market, VA 22844-9450 |
Second Address | New Market, VA 22844-9450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005337 | ANTHEM (01) | |
380876 | ANTHEM (01) | |
T21534 | (02) |