Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1427000314 |
---|---|
Provider Name | Mr. Douglas Paul Smith |
First Address | Louisville, KY 40206-1433 |
Second Address | Louisville, KY 40206-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 17/09/2008 |