Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 36416 | AZ |
NPI | 1033138706 |
---|---|
Provider Name | Michael Anthony Smith |
First Address | Phoenix, AZ 85013-4220 |
Second Address | Phoenix, AZ 85013-4220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 29/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170417 | (05) | AZ |