Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 63193 | TN |
NPI | 1073967949 |
---|---|
Provider Name | Samuel Henry Smith |
First Address | Memphis, TN 38119-0809 |
Second Address | Memphis, TN 38163-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2016 |
Last Update Date | 07/07/2021 |