Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1417353780 |
---|---|
Provider Name | Mr. Rodger Doyle Smith |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36693-3330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2014 |
Last Update Date | 13/11/2014 |