Healthcare Provider Details

I. General information

NPI: 1306893730
Provider Name (Legal Business Name): CLAYTON RHINE SMITH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 LENHART RD
FLEETWOOD PA
19522
US

IV. Provider business mailing address

12 LENHART RD PO BOX 425
FLEETWOOD PA
19522-8613
US

V. Phone/Fax

Practice location:
  • Phone: 610-944-6537
  • Fax: 610-914-8544
Mailing address:
  • Phone: 610-944-6537
  • Fax: 610-944-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC004516L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: