Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | OS16292 | FL |
NPI | 1386603934 |
---|---|
Provider Name | David L. Smull |
First Address | Rockledge, FL 32955-4306 |
Second Address | Melbourne, FL 32901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 19/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103960800 | (05) | FL |
G72875 | (02) | NC |
LN948 | MEDICARE (01) | FL |