Provider Demographics
NPI:1285840272
Name:LEE D. SMITH, DPM, PA
Entity Type:Organization
Organization Name:LEE D. SMITH, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-789-4556
Mailing Address - Street 1:PO BOX 15654
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-5654
Mailing Address - Country:US
Mailing Address - Phone:727-789-4556
Mailing Address - Fax:813-925-1435
Practice Address - Street 1:2451 N MCMULLEN BOOTH RD STE 206
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1362
Practice Address - Country:US
Practice Address - Phone:727-789-4556
Practice Address - Fax:813-925-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1914213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029712700Medicaid
FL65028Medicare ID - Type Unspecified
FLT85370Medicare UPIN