Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 006128 | GA |
N | 2080P0205X | Pediatric Endocrinologist | 2016007191 | MO |
Y | 2080P0205X | Pediatric Endocrinologist | 58328 | AZ |
NPI | 1518306448 |
---|---|
Provider Name | Pamela S.w. Smith |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006-1464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 06/09/2019 |