Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 22038 | MN |
NPI | 1033137849 |
---|---|
Provider Name | James M Smith |
First Address | St Cloud, MN 56303 |
Second Address | St Cloud, MN 56303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111041 | UCARE (01) | |
1324439 | MEDICA (01) | |
532001 | P-ONE (01) | |
56657SM | BCBS (01) | |
D80188 | (02) |