Provider Demographics
NPI:1538466719
Name:SMITH, CLARENCE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:EDWARD
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 1:424 W DILIDO DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1164
Mailing Address - Country:US
Mailing Address - Phone:305-531-4084
Mailing Address - Fax:305-531-6546
Practice Address - Street 1:424 W DILIDO DR
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1164
Practice Address - Country:US
Practice Address - Phone:305-531-4084
Practice Address - Fax:305-531-6546
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0039640208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice