Provider Demographics
NPI:1710097522
Name:SMART, WAIDE L (RRT)
Entity Type:Individual
Prefix:
First Name:WAIDE
Middle Name:L
Last Name:SMART
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 NW 22 AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2158
Mailing Address - Country:US
Mailing Address - Phone:954-579-7467
Mailing Address - Fax:
Practice Address - Street 1:3243 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-6497
Practice Address - Country:US
Practice Address - Phone:954-579-7467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered