Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | O0422 | ID |
NPI | 1013037522 |
---|---|
Provider Name | Lance Hubsmith |
First Address | Twin Falls, ID 83303-1657 |
Second Address | Twin Falls, ID 83301-7817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 14/08/2007 |