Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME39915 | FL |
NPI | 1013905280 |
---|---|
Provider Name | Ronald D Smith |
First Address | Hollywood, FL 33021-6748 |
Second Address | Hollywood, FL 33021-6748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E19718 | (02) | FL |