Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G83519 | CA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | G83519 | CA |
NPI | 1104875517 |
---|---|
Provider Name | Todd C Smith |
First Address | Modesto, CA 95355-4201 |
Second Address | Modesto, CA 95355-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 25/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G835190 | (05) | CA |
G47571 | (02) | CA |