Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 70780 | WI |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 70780 | WI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD60286469 | WA |
NPI | 1427218981 |
---|---|
Provider Name | Dr. Jason William Smith |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1427218981 | (05) | WA |
8911276 | MEDICARE PIN (01) | WA |