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General NPI Number Information
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NPI Number | 1831210715
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Entity Type | Individual
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Provider Name | KELLY SMITH MD
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 1525 W CYPRESS CREEK RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1831
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Country | US
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Telephone | 954-939-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 SE TIFFANY AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7521
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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 |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4301087897
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME106626
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License Number State | FL
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