Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1027420501 | UT |
Y | 222Z00000X | Podiatrist | 1027420501 | UT |
NPI | 1013972157 |
---|---|
Provider Name | Dr. Terry Paul Smith |
First Address | N Salt Lake, UT 84054-0610 |
Second Address | Salt Lake City, UT 84102-1686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 21/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013972157 | (05) | UT |
T48821 | (02) |