Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 00E2980 | CA |
Y | 222Z00000X | Podiatrist | 00E2980 | CA |
NPI | 1073538583 |
---|---|
Provider Name | Dr. Terry L Smith |
First Address | Auburn, CA 95602-7847 |
Second Address | Auburn, CA 95602-7847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I11540 | (02) | CA |