Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RS0012X | Sleep Medicine | M3394 | TX |
Y | 2080P0214X | Pediatric Pulmonologist | M3394 | TX |
NPI | 1528198405 |
---|---|
Provider Name | Dr. Kelly J Smith |
First Address | San Antonio, TX 78231 |
Second Address | San Antonio, TX 78231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 20/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19177340-02 | (05) | TX |