Provider Demographics
NPI:1427376425
Name:SMITH, ZACHARY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1834
Mailing Address - Country:US
Mailing Address - Phone:407-897-3499
Mailing Address - Fax:
Practice Address - Street 1:1812 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1834
Practice Address - Country:US
Practice Address - Phone:407-897-3499
Practice Address - Fax:407-896-9454
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018016011208800000X, 208600000X
FLME163757208800000X
IL036.139539208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200054363Medicaid
FL015003500Medicaid