Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 08808 | MS |
NPI | 1063597227 |
---|---|
Provider Name | Dr. William R Smith |
First Address | Flowood, MS 39232-7607 |
Second Address | Flowood, MS 39232-7607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 05/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00115699 | (05) | MS |
E41118 | (02) |