Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 0416074 | KS |
Y | 208200000X | Surgeon | 04-16074 | KS |
Y | 208600000X | Surgeon | 04-16074 | KS |
NPI | 1669470290 |
---|---|
Provider Name | Dr. John L Smith |
First Address | Wichita, KS 67214-3729 |
Second Address | Wichita, KS 67214-3729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 14/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100162260B | (05) | KS |
A03154 | (02) | KS |