Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 45611 | CO |
N | 207RX0202X | Medical Oncology | MD38769 | TN |
NPI | 1164519922 |
---|---|
Provider Name | Dr. Susan E Smith |
First Address | Durango, CO 81301-7300 |
Second Address | Durango, CO 81301-7300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15559297 | (05) | CO |
3339462 | (05) | TN |
3339463 | (05) | TN |
517659 | (05) | AZ |
BS6658530 | DEA (01) | |
H21133 | (02) |