Provider Demographics
NPI:1558368670
Name:SMIH, DOUGLAS RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RANDALL
Last Name:SMIH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4723 W ATLANTIC AVE
Mailing Address - Street 2:STE 10
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3865
Mailing Address - Country:US
Mailing Address - Phone:561-819-0821
Mailing Address - Fax:561-819-0824
Practice Address - Street 1:4723 W ATLANTIC AVE
Practice Address - Street 2:STE 10
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3865
Practice Address - Country:US
Practice Address - Phone:561-819-0821
Practice Address - Fax:561-819-0824
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62450170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE64586Medicare UPIN
FL17856DMedicare ID - Type Unspecified