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Individual
AMANDA SMITH
Active
Individual
AMANDA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01077946A
IN
207Q00000X
Family Medicine Physician
Primary
163991
AK
390200000X
Student in an Organized Health Care Education/Training Program
11017833A
IN
Other
Enumeration date
06/12/2014
Last updated
12/07/2021
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