Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 44301070941 | MI |
N | 2081P2900X | Pain Medicine | 4301070941 | MI |
NPI | 1023190923 |
---|---|
Provider Name | Matthew W Smuck |
First Address | Redwood City, CA 94063-3132 |
Second Address | Redwood City, CA 94063-3132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 23/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4463978 | (05) | MI |
H48022 | (02) | MI |