Healthcare Provider Details

I. General information

NPI: 1790735710
Provider Name (Legal Business Name): RONALD D SMITH AND EDUARDO WEISS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 HOLLYWOOD BLVD SUITE 301
HOLLYWOOD FL
33021-6748
US

IV. Provider business mailing address

3850 HOLLYWOOD BLVD SUITE 301
HOLLYWOOD FL
33021-6748
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-1200
  • Fax: 954-963-0378
Mailing address:
  • Phone: 954-961-1200
  • Fax: 954-963-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number75865
License Number StateFL

VIII. Authorized Official

Name: MISS JULIE SOTO
Title or Position: MANAGER
Credential:
Phone: 954-961-1200