Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CO002952 | |
Y | 222Z00000X | Podiatrist | CO002952 | |
N | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1528364098 |
---|---|
Provider Name | Mr. Robert A Smith |
First Address | Walnut Creek, CA 94598-2417 |
Second Address | Walnut Creek, CA 94598-2417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2011 |
Last Update Date | 21/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XA0029520 | (05) | CA |