Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD60353787 | WA |
N | 208600000X | Surgeon | MD60353787 | WA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD60353787 | WA |
NPI | 1003988312 |
---|---|
Provider Name | Mary Cristina Smith |
First Address | Spokane, WA 99204-2321 |
Second Address | Spokane, WA 99204-2321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2027727 | (05) | WA |
938178 | (05) | AZ |
I31425 | (02) |