Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A21571 | CA |
N | 207ND0900X | Dermatopathologist | A21571 | CA |
N | 207NS0135X | Procedural Dermatology | A21571 | CA |
NPI | 1063480473 |
---|---|
Provider Name | Mr. Paul Lawrence Smith |
First Address | Santa Monica, CA 90404-2102 |
Second Address | Santa Monica, CA 90404-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 04/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W8759 | (02) | CA |