Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 36132 | IA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 01060331A | IN |
N | 207XS0117X | Orthopaedic Spine Surgeon | 36132 | IA |
NPI | 1225029655 |
---|---|
Provider Name | Joseph Douglas Smucker |
First Address | Carmel, IN 46032-5480 |
Second Address | Carmel, IN 46032-5480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 07/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0469718 | (05) | IA |
39298 | WELLMARK BCBS (01) | IA |
I12463 | (02) |