Provider Demographics
NPI:1366681892
Name:SMITH, CHRISTOPHER JACOB (DO)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JACOB
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N STATE ROAD 7 STE 105
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4816
Mailing Address - Country:US
Mailing Address - Phone:954-541-2739
Mailing Address - Fax:954-541-2741
Practice Address - Street 1:4000 N STATE ROAD 7 STE 105
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-4816
Practice Address - Country:US
Practice Address - Phone:954-541-2739
Practice Address - Fax:954-541-2741
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251824207N00000X, 207Q00000X
FLOS10662207Q00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine