Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 162577-1205 | UT |
N | 207VX0201X | Gynecologic Oncologist | 162577-8905 | UT |
NPI | 1265825319 |
---|---|
Provider Name | Dr. William Gary Smith |
First Address | Park City, UT 84060 |
Second Address | Park City, UT 84060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2015 |
Last Update Date | 23/03/2015 |