Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD012400E | PA |
Y | 208600000X | Surgeon | MD012400E | PA |
NPI | 1003819079 |
---|---|
Provider Name | Dr. Robert D. Smink JR. |
First Address | Wynnewood, PA 19096-3450 |
Second Address | Wynnewood, PA 19096-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000703136-0003 | (05) | PA |
B36586 | (02) |