Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | DOS 1169 | HI |
N | 111NI0900X | Internist | DOS 1169 | HI |
Y | 207RG0300X | Geriatric Medicine | DOS 1169 | HI |
NPI | 1124239389 |
---|---|
Provider Name | Toby Lee Smith |
First Address | Dalton, GA 30722-2091 |
Second Address | Kailua Kona, HI 96740-7616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2007 |
Last Update Date | 30/06/2020 |