Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 212 | AL |
N | 213ES0103X | Foot & Ankle Surgery | 212 | AL |
NPI | 1275581704 |
---|---|
Provider Name | J D Smith |
First Address | Florence, AL 35630-1769 |
Second Address | Florence, AL 35630-1769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 30/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1992977102 | MEDICARE GROUP NUMBER (01) | |
480002775 | MEDICARE RAILROAD PTAN (01) | |
51017836 | BCBS PROVIDER (01) | AL |
U75042 | (02) |