Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 200500833 | NC |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 53143 | AZ |
NPI | 1225098908 |
---|---|
Provider Name | Patricia Anne Smith |
First Address | Flagstaff, AZ 86001-3118 |
Second Address | Cottonwood, AZ 86326-4126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5901606 | (05) | NC |
I42808 | (02) | NC |