Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 012355 | ME |
NPI | 1033109624 |
---|---|
Provider Name | Neil D. Smith |
First Address | Rockport, ME 04856-4243 |
Second Address | Rockport, ME 04856-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D03602 | (02) |