Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO3096 | FL |
Y | 222Z00000X | Podiatrist | PO3096 | FL |
N | 213ES0131X | Foot Surgery | PO3096 | FL |
NPI | 1174511018 |
---|---|
Provider Name | Smita Malhotra |
First Address | Jacksonville, FL 32255-1380 |
Second Address | Ponte Vedra Beach, FL 32082-5048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 16/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U5471X | (02) | |
V05062 | (02) | FL |