Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125066370 | IL |
N | 111NI0900X | Internist | 125066370 | IL |
Y | 2084N0400X | Neurologist | 11293283-1205 | UT |
N | 2084N0400X | Neurologist | 125066370 | IL |
NPI | 1013398056 |
---|---|
Provider Name | Tammy L Smith |
First Address | Salt Lake City, UT 84132-0001 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2015 |
Last Update Date | 18/05/2021 |