Healthcare Provider Details

I. General information

NPI: 1861442279
Provider Name (Legal Business Name): BRIGETTE SMITH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92410 OVERSEAS HWY SUITE 1
TAVERNIER FL
33070-2636
US

IV. Provider business mailing address

PO BOX 378485
KEY LARGO FL
33037-8485
US

V. Phone/Fax

Practice location:
  • Phone: 305-852-8395
  • Fax:
Mailing address:
  • Phone: 305-852-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 3089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: