Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 7778 | SC |
NPI | 1265414593 |
---|---|
Provider Name | Dr. Sidney Terrell Smith |
First Address | West Columbia, SC 29171-2046 |
Second Address | Columbia, SC 29210-8239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 17/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
077785 | (05) | SC |
D99267 | (02) |