Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 08438 | TX |
Y | 111NI0900X | Internist | 08438 | TX |
N | 207RH0002X | Hospice and Palliative Medicine | 08438 | TX |
NPI | 1235291139 |
---|---|
Provider Name | Ken Rogers Smith |
First Address | San Antonio, TX 78256-2306 |
Second Address | San Antonio, TX 78228-1328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 21/09/2010 |