Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | PA383 | ID |
NPI | 1013905793 |
---|---|
Provider Name | Jeffrey D Smith |
First Address | Boise, ID 83707-2985 |
Second Address | Boise, ID 83704-9066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 12/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
806233100 | (05) | ID |
P26087 | (02) |