Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 00001761 | AL |
NPI | 1083671317 |
---|---|
Provider Name | Rufus Clyde Smith |
First Address | Dothan, AL 36305-4300 |
Second Address | Dothan, AL 36305-4300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 11/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000076354 | (05) | AL |
C75018 | (02) |