Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 333284-1205 | UT |
Y | 207YP0228X | Pediatric Otolaryngology | 333284-1205 | UT |
NPI | 1154411783 |
---|---|
Provider Name | Marshall E. Smith |
First Address | Salt Lake City, UT 84158-1094 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 17/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
805065800 | (05) | ID |
990009279 | RAILROAD MEDICARE (01) | UT |
D1815 | (05) | UT |
E61977 | (02) | UT |