Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0122X | Plastic and Reconstructive Surgery | 101951 | MN |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 4390 | IA |
NPI | 1245274745 |
---|---|
Provider Name | Leslie W Smith |
First Address | Mason City, IA 50401-5489 |
Second Address | Mason City, IA 50401-2737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 18/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I02230 | (02) |