Healthcare Provider Details

I. General information

NPI: 1487719365
Provider Name (Legal Business Name): GINA ELAINA MORGAN-SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15490 NW 7TH AVE
MIAMI FL
33169-6250
US

IV. Provider business mailing address

15490 NW 7TH AVE
MIAMI FL
33169-6250
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-0381
  • Fax: 305-687-8747
Mailing address:
  • Phone: 305-685-0381
  • Fax: 305-687-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0065123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: