Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 57009416 | OH |
Y | 207W00000X | Ophthalmologist | 66645 | GA |
NPI | 1003017468 |
---|---|
Provider Name | Dr. Ryan Thomas Smith |
First Address | Augusta, GA 30909-5625 |
Second Address | Augusta, GA 30909-5625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 28/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202I183712 | PTAN (01) | GA |
2965260 | (05) | OH |
P00725745 | RAILROAD MEDICARE (01) | KY |
P00748929 | RAILROAD MEDICARE (01) | OH |