Provider Demographics
NPI:1457453532
Name:SMITH, LEROY ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1625 SE 3 AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2521
Mailing Address - Country:US
Mailing Address - Phone:954-522-1982
Mailing Address - Fax:954-527-4938
Practice Address - Street 1:1625 SE 3 AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-522-1982
Practice Address - Fax:954-527-4938
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014162207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D63076Medicare UPIN
93966Medicare ID - Type Unspecified