Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0122X | Plastic and Reconstructive Surgery | 22000 | WV |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 41340 | KY |
NPI | 1235124637 |
---|---|
Provider Name | Henry Garth Smith |
First Address | Madisonville, KY 42431-9443 |
Second Address | Madisonville, KY 42431-9443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 03/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000532699 | BCBS (01) | KY |
7100023940 | (05) | KY |