=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881945418
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA YVONNE SMITH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2012
-----------------------------------------------------
Last Update Date | 09/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 831 W MORGAN ST 4278 MSC
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27699-4278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-838-4000
-----------------------------------------------------
Fax | 919-733-1415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 831 W MORGAN ST 4278 MSC
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27699-4278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-838-4000
-----------------------------------------------------
Fax | 919-733-1415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 28829
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------