Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 12089 | AZ |
NPI | 1013071646 |
---|---|
Provider Name | William Smith JR. |
First Address | Paradise Valley, AZ 85253-4154 |
Second Address | Paradise Valley, AZ 85253-4154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12089 | STATE LICENSE (01) | AZ |
D90935 | (02) |