Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 27940 | IA |
Y | 207YP0228X | Pediatric Otolaryngology | 27940 | IA |
NPI | 1194718213 |
---|---|
Provider Name | Richard J Smith |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 18/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0069229 | (05) | IA |
02402 | WELLMARK BCBS (01) | IA |
C21961 | (02) |