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General NPI Number Information
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NPI Number | 1831193697
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Entity Type | Individual
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Provider Name | LESLIE L. SMITH D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 2400 STATE ROAD 415
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City | SANFORD
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State | FL
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Zip | 32771-6012
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Country | US
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Telephone | 407-322-8645
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Fax | 407-324-7311
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Provider Business Mailing Address
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Address Line | 2400 STATE ROAD 415
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City | SANFORD
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State | FL
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Zip | 32771-6012
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Country | US
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Telephone | 407-322-8645
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Fax | 407-324-7311
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS0007694
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License Number State | FL
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