Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | WA | |
Y | 222Z00000X | Podiatrist | WA | |
N | 224P00000X | Prosthetist | WA |
NPI | 1245574565 |
---|---|
Provider Name | Michael Smith |
First Address | Everett, WA 98203-2200 |
Second Address | Everett, WA 98203-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2012 |
Last Update Date | 12/06/2013 |