Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 43 | TX |
NPI | 1992769020 |
---|---|
Provider Name | Mr. Ray D. Smith |
First Address | Victoria, TX 77903-4646 |
Second Address | Victoria, TX 77901-2679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LPO43 | TX BOARD OF P & O (01) | TX |