Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | E3427 | AR |
NPI | 1538134572 |
---|---|
Provider Name | Dr. Shane R Smith |
First Address | Jonesboro, AR 72401-3145 |
Second Address | Jonesboro, AR 72401-3145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 23/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
146939001 | (05) | AR |
5M220 | BCBS OF AR (01) | AR |
H64227 | (02) | AR |
P00062106 | RAILROAD MEDICARE (01) | AR |