Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1071 | NE |
NPI | 1952343055 |
---|---|
Provider Name | Dr. Thomas Lee Smith |
First Address | Bellevue, NE 68123-2412 |
Second Address | Bellevue, NE 68123-2412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47082778900 | (05) | NE |
U44312 | (02) | NE |