Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 1045170501 | UT |
NPI | 1043283856 |
---|---|
Provider Name | Stanton Miller Smith |
First Address | Murray, UT 84107-5421 |
Second Address | Murray, UT 84107-5421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 26/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T77971 | (02) | UT |