Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 12751 | LA |
NPI | 1497234660 |
---|---|
Provider Name | Robert Lewis Smith |
First Address | Keithville, LA 71047-6529 |
Second Address | Keithville, LA 71047-6529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2018 |
Last Update Date | 08/08/2018 |