Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME0049931 | FL |
N | 207VG0400X | Gynecologist | ME0049931 | FL |
N | 207VX0000X | Obstetrician | ME0049931 | FL |
NPI | 1235130022 |
---|---|
Provider Name | Dr. Stephen Gregory Smith |
First Address | Panama City, FL 32405-4517 |
Second Address | Panama City, FL 32405-4517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 16/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049372400 | (05) | FL |
07557 | BC/BS (01) | FL |