Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 114330 | MO |
NPI | 1003959099 |
---|---|
Provider Name | Dr. Michael P. Smith-O'brien |
First Address | Springfield, MO 65801-2580 |
Second Address | Springfield, MO 65804-2265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 02/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140125001 | (05) | AR |
209732403 | (05) | MO |
81512 | AR BLUE SHIELD # (01) | MO |
F59160 | (02) | MO |