MEDICARE: RAYLAN DALE SMITH CST/CFA

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	246ZC0007X	Surgical Assistant	111679	FL

General Provider Information

NPI Number	:	1285871863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYLAN DALE SMITH CST/CFA

Provider Business Mailing Address
First Line	:	PO BOX 970528
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33097-0528
Country	:	US
Telephone Number	:	954-227-8224
Fax Number	:	954-227-7442

Provider Business Practice Location Address
First Line	:	10531 NW 57TH ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2807
Country	:	US
Telephone Number	:	954-227-8224
Fax Number	:	954-227-7442

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

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	01/19/2009

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Directions to “ RAYLAN DALE SMITH CST/CFA” Practice Location

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