Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 2018029428 | MO |
N | 2086X0206X | Surgical Oncologist | MD-1040 | HI |
NPI | 1033303276 |
---|---|
Provider Name | Richard Smith |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2007 |
Last Update Date | 27/10/2021 |