Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | C41618 | CA |
N | 208600000X | Surgeon | C41618 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | C41618 | CA |
NPI | 1023082971 |
---|---|
Provider Name | Mont Anthony Smith |
First Address | Huntington Park, CA 90255 |
Second Address | Huntington Park, CA 90255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52175 | (02) | |
GR0040370 | (05) | CA |