Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME 49162 | FL |
NPI | 1700034345 |
---|---|
Provider Name | Dr. Larry Nelson Smith |
First Address | Gainesville, FL 32608-8937 |
Second Address | Gainesville, FL 32608-8937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2008 |
Last Update Date | 08/09/2008 |