Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 35041759 | OH |
NPI | 1316932403 |
---|---|
Provider Name | Dr. Mary R. Smith |
First Address | Toledo, OH 43614-2426 |
Second Address | Toledo, OH 43614-5811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0357993 | (05) | OH |
C01497 | (02) |