Provider Demographics
NPI:1578543195
Name:SMITH, DOUGLAS F (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:F
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 1:603 N FLAMINGO ROAD
Mailing Address - Street 2:SUITE 361
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028
Mailing Address - Country:US
Mailing Address - Phone:954-432-7900
Mailing Address - Fax:954-433-4903
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:#361
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-432-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7299207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15734OtherBCBS
FL263313200Medicaid
FL15734WMedicare PIN
G25209Medicare UPIN
FL15734XMedicare PIN
FL15734YMedicare PIN
FL15734NMedicare PIN
FL15734UMedicare PIN
FL15734RMedicare PIN
FL15734SMedicare PIN
FL15734ZMedicare PIN
FL15734OtherBCBS
FL15734VMedicare PIN