Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 045459 | CT |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 045459 | CT |
N | 208800000X | Urologist | 045459 | CT |
N | 2088P0231X | Pediatric Urologist | 045459 | CT |
NPI | 1245450154 |
---|---|
Provider Name | Dr. Phillip P Smith |
First Address | Farmington, CT 06030-0001 |
Second Address | Farmington, CT 06030-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 02/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245450154 | (05) | CT |