MEDICARE: RONALD D SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME39915	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013905280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD D SMITH MD

Provider Business Mailing Address
First Line	:	3850 HOLLYWOOD BLVD
Second Line	:	STE 301
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6748
Country	:	US
Telephone Number	:	954-961-1200
Fax Number	:	954-963-0378

Provider Business Practice Location Address
First Line	:	3850 HOLLYWOOD BLVD
Second Line	:	SUITE 301
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6748
Country	:	US
Telephone Number	:	954-961-1200
Fax Number	:	954-963-0378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/08/2007

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