Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 177741-1 | NY |
N | 208600000X | Surgeon | 177741-1 | NY |
Y | 2086X0206X | Surgical Oncologist | 4301104264 | MI |
NPI | 1154302172 |
---|---|
Provider Name | Judy Lynn Smith |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 16/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154302172 | NPI (01) | MI |
4301104264 | MICHIGAN LICENSE (01) | MI |