Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 24197 | NE |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME134346 | FL |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | ME134346 | FL |
NPI | 1134112261 |
---|---|
Provider Name | Russell B Smith |
First Address | Jacksonville, FL 32232-5278 |
Second Address | Jacksonville, FL 32207-8432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 01/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0212142 | (05) | IA |
10025044400 | (05) | NE |
1134112261 | (05) | IA |
19770 | WELLMARK BCBS (01) | IA |
47078557504 | (05) | NE |
H20445 | (02) |