MEDICARE: CHARLES LEE SMITH D.O.

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	208D00000X	General Practice Physician	832	WV
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	OS15367	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	832	OTHER	WV	STATE LICENSE
2	OS15367	OTHER	FL	1841419058

General Provider Information

NPI Number	:	1841419058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LEE SMITH D.O.

Provider Business Mailing Address
First Line	:	3600 RED RD STE 501
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6015
Country	:	US
Telephone Number	:	954-947-3290
Fax Number	:	866-572-2146

Provider Business Practice Location Address
First Line	:	3600 RED RD STE 501
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025
Country	:	US
Telephone Number	:	954-947-3290
Fax Number	:	866-572-2146

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	01/19/2026

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