Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MT195434 | PA |
Y | 208600000X | Surgeon | MT195434 | PA |
NPI | 1003042730 |
---|---|
Provider Name | Kimberly Smith |
First Address | Philadelphia, PA 19130-3601 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 09/06/2009 |