Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 118818 | NY |
N | 207X00000X | Orthopaedic Surgeon | 35-054531 | OH |
N | 2086S0120X | Pediatric Surgery | 35-054531 | OH |
NPI | 1093809261 |
---|---|
Provider Name | Dr. Jude T. Smith |
First Address | Olean, NY 14760 |
Second Address | Olean, NY 14760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 22/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0654706 | (05) | OH |
A16749 | (02) |