Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 200301293 | NC |
N | 111NI0900X | Internist | 200301293 | NC |
Y | 207RA0401X | Internist - Addiction Medicine | 200301293 | NC |
N | 208200000X | Surgeon | 200301293 | NC |
N | 208600000X | Surgeon | 200301293 | NC |
NPI | 1154340594 |
---|---|
Provider Name | Michael L. Smith |
First Address | Duck, NC 27949-4570 |
Second Address | Duck, NC 27949-4570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 16/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B06622 | (02) |