Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 37771 | MN |
NPI | 1336178896 |
---|---|
Provider Name | Stanley Lamar Smith |
First Address | Stillwater, MN 55082-6040 |
Second Address | Stillwater, MN 55082-6040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 15/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
156814100 | (05) | MN |
F27236 | (02) | MN |