Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35.049915 | OH |
NPI | 1013095298 |
---|---|
Provider Name | Mark Smith |
First Address | Columbus, OH 43221-2406 |
Second Address | Columbus, OH 43221-2406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D89550 | (02) | OH |