Healthcare Provider Details

I. General information

NPI: 1013905280
Provider Name (Legal Business Name): RONALD D SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
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 STE 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 Code207N00000X
TaxonomyDermatology Physician
License NumberME39915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: