Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 2016007352 | MO |
N | 207RG0100X | Gastroenterologist | 34.012657 | OH |
Y | 207RG0100X | Gastroenterologist | 60377 | WI |
NPI | 1003048976 |
---|---|
Provider Name | Dr. Zachary Smith |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 16/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003048976 | (05) | WI |