Healthcare Provider Details

I. General information

NPI: 1235699679
Provider Name (Legal Business Name): LATOYA MARIE SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

3200 BURNET AVE
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.147981
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: