MEDICARE: DR. JACQUELINE ELIZABETH SMITH M.D.

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	207W00000X	Ophthalmology Physician	71500	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396709689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE ELIZABETH SMITH M.D.

Provider Business Mailing Address
First Line	:	4101 NW 4TH ST
Second Line	:	# 409
City	:	PLANTATION
State	:	FL
Zip	:	33317-2836
Country	:	US
Telephone Number	:	954-321-9555
Fax Number	:	954-321-9557

Provider Business Practice Location Address
First Line	:	4101 NW 4TH ST
Second Line	:	# 409
City	:	PLANTATION
State	:	FL
Zip	:	33317-2850
Country	:	US
Telephone Number	:	954-321-9555
Fax Number	:	954-321-9557

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	09/18/2019

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