Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | G55045 | CA |
N | 208000000X | Pediatrician | MD26976 | OR |
Y | 2080P0204X | Pediatric Emergency Doctor | MD26976 | OR |
NPI | 1699796201 |
---|---|
Provider Name | Kathleen M Smith |
First Address | San Diego, CA 92123-4223 |
Second Address | Hillsboro, OR 97124-9224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 23/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
298528 | (05) | OR |
8129355 | (05) | WA |
A93349 | (02) |