Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 0101226185 | VA |
NPI | 1023091295 |
---|---|
Provider Name | Jean A Smith |
First Address | Roanoke, VA 24014-6546 |
Second Address | Roanoke, VA 24014-2462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 12/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5844126 | (05) | VA |
5886783 | (05) | VA |
C21927 | (02) | VA |