Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 03402 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 03402 | KY |
NPI | 1649226895 |
---|---|
Provider Name | Paul E Smith III |
First Address | Winchester, KY 40391-9216 |
Second Address | Jackson, KY 41339-0714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114947926 | (05) | MI |
7100177400 | (05) | KY |
F52011 | (02) | MI |
PS012921 | BLUE CROSS (01) | MI |