Individual
MARY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(812) 353-9515
(812) 353-9275
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
(812) 353-3087
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01031934A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100342780
—
IN
Enumeration date
08/04/2006
Last updated
12/30/2014
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