Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 138636 | NY |
NPI | 1235129933 |
---|---|
Provider Name | Roy A Smith |
First Address | Syracuse, NY 13202-3527 |
Second Address | Syracuse, NY 13202-3527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 27/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00831732 | (05) | NY |
C59280 | (02) | NY |