Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 0423021 | KS |
NPI | 1013970979 |
---|---|
Provider Name | Rachel S Smith |
First Address | Lawrence, KS 66046-4827 |
Second Address | Lawrence, KS 66046-4827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 14/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100116690C | (05) | KS |
102792 | BLUE CROSS BLUE SHIELD (01) | KS |
E11559 | (02) | KS |