Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A85396 | CA |
N | 207X00000X | Orthopaedic Surgeon | M-9725 | ID |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | M-9725 | ID |
N | 207XS0106X | Orthopaedic Hand Surgeon | M-9725 | ID |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | M-9725 | ID |
N | 207XS0117X | Orthopaedic Spine Surgeon | M-9725 | ID |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M-9725 | ID |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | M-9725 | ID |
N | 207XX0801X | Orthopaedic Trauma Surgeon | M-9725 | ID |
NPI | 1295890101 |
---|---|
Provider Name | Dr. P. Bertil Weldon Smith |
First Address | San Marcos, CA 92078-4201 |
Second Address | San Marcos, CA 92078-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 18/10/2021 |