Healthcare Provider Details

I. General information

NPI: 1376505271
Provider Name (Legal Business Name): WEBER LEE SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5542 HIGH ST SUITE C
NEW PORT RICHEY FL
34652-4026
US

IV. Provider business mailing address

PO BOX 552279
TAMPA FL
33655-0001
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-4848
  • Fax: 727-842-9513
Mailing address:
  • Phone: 800-664-3939
  • Fax: 843-284-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME52263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: