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General NPI Number Information
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NPI Number | 1174703318
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Entity Type | Organization
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Legal Business Name | CITRUS PARK DERMATOLOGY, PA
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 6540 GUNN HWY
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City | TAMPA
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State | FL
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Zip | 33625-4022
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Country | US
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Telephone | 813-269-4122
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Fax |
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Provider Business Mailing Address
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Address Line | 6540 GUNN HWY
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City | TAMPA
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State | FL
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Zip | 33625-4022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIMBERLY E. SMITH
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Credential | M.D.
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Telephone | 813-269-4122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME 72688
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License Number State | FL
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