Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | C13861A | CA |
NPI | 1003874504 |
---|---|
Provider Name | Dr. Samuel J Smith |
First Address | Beverly Hills, CA 90211 |
Second Address | Beverly Hills, CA 90211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G138610 | (05) | CA |
A90290 | (02) |