Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 20A7400 | CA |
NPI | 1003856931 |
---|---|
Provider Name | Timothy S Smith |
First Address | Westminster, CA 92685-1359 |
Second Address | Napa, CA 94558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 22/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AX74000 | (05) | CA |
H09702 | (02) |