Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 3083326-1205 | UT |
Y | 207V00000X | Obstetrician & Gynecologist | MD00044139 | WA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD00044139 | WA |
NPI | 1710954375 |
---|---|
Provider Name | Larry D Smith |
First Address | Richland, WA 99352-9532 |
Second Address | Richland, WA 99352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 01/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0272100 | LABOR & INDUSTRIES (01) | WA |
G72797 | (02) | UT |