Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PTP-PT-LIC-17057 | MT |
Y | 213ES0000X | Sports Medicine | PTP-PT-LIC-17057 | MT |
NPI | 1144887654 |
---|---|
Provider Name | Jeffrey Smith |
First Address | Billings, MT 59102-2666 |
Second Address | Billings, MT 59102-2666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 21/05/2019 |