Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 239521 | NY |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35-081746 | OH |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35081746 | OH |
Y | 207YS0123X | Facial Plastic Surgeon | 35-081746 | OH |
NPI | 1518923119 |
---|---|
Provider Name | Stephen P. Smith JR. |
First Address | Gahanna, OH 43230-6884 |
Second Address | Gahanna, OH 43230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2006 |
Last Update Date | 17/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2387019 | (05) | OH |
2599942 | (05) | OH |
H80495 | (02) |