Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 41039 | KY |
Y | 207QS0010X | Family Doctor - Sports Medicine | 41039 | KY |
NPI | 1205026093 |
---|---|
Provider Name | Milton Kyle Smoot |
First Address | Lexington, KY 40536-0001 |
Second Address | Lexington, KY 40504-3504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2007 |
Last Update Date | 21/07/2015 |