Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | A30448 | CA |
NPI | 1003894213 |
---|---|
Provider Name | Mr. Curtis Nathaniel Smith SR. |
First Address | Mount Shasta, CA 96067-2617 |
Second Address | Mount Shasta, CA 96067-2206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 23/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A304480 | (05) | CA |
A30448 | BLUE CROSS (01) | |
D41135 | (02) | |
P00464316 | RAILROAD MEDICARE (01) | CA |