Provider Demographics
NPI:1295969947
Name:SMITH, DENISE ANNE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD, PHD
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Mailing Address - Street 1:332 MEDCREST DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-6440
Mailing Address - Country:US
Mailing Address - Phone:850-682-0032
Mailing Address - Fax:850-682-0034
Practice Address - Street 1:332 MEDCREST DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6440
Practice Address - Country:US
Practice Address - Phone:850-682-0032
Practice Address - Fax:850-682-0034
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1313962086S0129X
FLME1291042086S0129X
GA956082086S0129X
VA01012691302086S0129X
MDD00892782086S0129X
OH35.0991032086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery