Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 10167873A | IN |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 01067873A | IN |
NPI | 1093918476 |
---|---|
Provider Name | Dr. Jon B Smucker |
First Address | Elkhart, IN 46514-1228 |
Second Address | Elkhart, IN 46514-1228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 20/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200981040 | (05) | IN |