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Individual
MR. CODY CHARLES SMITH
Active
Individual
MR. CODY CHARLES SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2484
ID
363A00000X
Physician Assistant
PA57810
CA
363AM0700X
Medical Physician Assistant
PA57810
CA
Other
Enumeration date
02/11/2020
Last updated
08/08/2024
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