Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DE60831843 | WA |
Y | 213EG0000X | General Practice | DE60831843 | WA |
NPI | 1003312596 |
---|---|
Provider Name | Jarom Alexander Smith |
First Address | Yakima, WA 98901-3534 |
Second Address | Yakima, WA 98901-3534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2018 |
Last Update Date | 03/04/2018 |