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General NPI Number Information
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NPI Number | 1366681892
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Entity Type | Individual
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Provider Name | CHRISTOPHER JACOB SMITH D.O
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Gender | Male
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 11/28/2024
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Provider Practice Location Address
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Address Line | 4300 N UNIVERSITY DR STE C100
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City | LAUDERHILL
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State | FL
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Zip | 33351-6243
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Country | US
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Telephone | 954-314-7671
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Fax | 954-900-2372
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Provider Business Mailing Address
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Address Line | 4300 N UNIVERSITY DR STE C100
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City | LAUDERHILL
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State | FL
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Zip | 33351-6243
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Country | US
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Telephone | 954-314-7671
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Fax | 954-900-2372
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 251824
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 251824
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS10662
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS10662
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License Number State | FL
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