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Individual
ROGER DALE SMITH
Active
Individual
ROGER DALE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268949609
—
MO
05
—
288949605
—
MO
05
—
858949605
—
MO
Enumeration date
05/10/2007
Last updated
07/09/2007
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