Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD28619 | TN |
Y | 208600000X | Surgeon | MD28619 | TN |
N | 2086S0102X | Surgical Critical Care | MD28619 | TN |
NPI | 1134113707 |
---|---|
Provider Name | Dr. Philip W Smith |
First Address | Chattanooga, TN 37403-2136 |
Second Address | Chattanooga, TN 37403-2136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 18/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2536483 | (05) | OH |
2611015 | CIGNA (01) | |
4085131 | BCBS OF TN (01) | |
830964577B | (05) | GA |
F30736 | (02) | |
Q002533 | (05) | TN |
TN0185 | JDH (01) |