Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 10222696-1205 | UT |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 10222696-1205 | UT |
NPI | 1740721810 |
---|---|
Provider Name | Dr. Kristine Anne Smith |
First Address | Calgary, AB T2N3L1 |
Second Address | Salt Lake City, UT 84132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2017 |
Last Update Date | 24/04/2017 |