Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME41364 | FL |
NPI | 1003809021 |
---|---|
Provider Name | Dr. Matthew S. Smith |
First Address | Lakeland, FL 33812-7700 |
Second Address | Lakeland, FL 33812-7700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 19/03/2020 |