Healthcare Provider Details

I. General information

NPI: 1487886016
Provider Name (Legal Business Name): HEATHER CAMILLE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2009
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-1515
  • Fax: 305-662-3723
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.097475
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME121290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: