Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 210281 | MA |
Y | 207XX0801X | Orthopaedic Trauma Surgeon | 210281 | MA |
NPI | 1235125469 |
---|---|
Provider Name | Dr. Raymond Malcolm Smith |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0176656 | (05) | MA |
H52956 | (02) | MA |