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Individual

MR. ROBERT A SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CO

Taxonomy

Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CO002952
224P00000X
Prosthetist
225000000X
Orthotic Fitter
246Z00000X
Other Specialist/Technologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
XA0029520
CA
Enumeration date
02/01/2011
Last updated
03/21/2013
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