Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0378 | NH |
N | 222Z00000X | Podiatrist | 0378 | NH |
Y | 2081S0010X | Sports Medicine | 0378 | NH |
Y | 213ES0000X | Sports Medicine | 0378 | NH |
N | 213ES0103X | Foot & Ankle Surgery | 0560000181 | VT |
N | 213ES0131X | Foot Surgery | 0378 | NH |
NPI | 1275712390 |
---|---|
Provider Name | Paul Robert Smith |
First Address | Lebanon, NH 03766-2900 |
Second Address | Lebanon, NH 03766-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2007 |
Last Update Date | 26/01/2022 |