Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 37770 | OH |
NPI | 1184722589 |
---|---|
Provider Name | Dr. Robert J Smyth |
First Address | Cincinnati, OH 45208-2108 |
Second Address | Cincinnati, OH 45238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0428531 | (05) | OH |
31-1080786 | TAX ID # (01) | OH |
A75018 | (02) | OH |