Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 26299 | MS |
NPI | 1104183938 |
---|---|
Provider Name | Haller Jackson Smith |
First Address | Birmingham, AL 35249-1900 |
Second Address | Birmingham, AL 35249-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 26/11/2019 |