Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC-002658L | PA |
Y | 222Z00000X | Podiatrist | SC-002658L | PA |
NPI | 1053350272 |
---|---|
Provider Name | Dr. Ronald Lee Smith |
First Address | Upper Darby, PA 19082-3603 |
Second Address | Upper Darby, PA 19082-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 01/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0940050 | (05) | PA |
T30493 | (02) | PA |