Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101245403 | VA |
NPI | 1063484863 |
---|---|
Provider Name | Richard Francis Smith |
First Address | Danville, VA 24541-4160 |
Second Address | Danville, VA 24541-4160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 10/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063484863 | (05) | VA |
1063484863 | ANTHEM BCBS (01) | VA |
89133JJ | (05) | NC |
C69700 | (02) | NC |