Provider Demographics
NPI:1790735710
Name:RONALD D SMITH AND EDUARDO WEISS MD PA
Entity Type:Organization
Organization Name:RONALD D SMITH AND EDUARDO WEISS MD PA
Other - Org Name:DERMATOLOGY & COSMETIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-961-1200
Mailing Address - Street 1:3850 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6748
Mailing Address - Country:US
Mailing Address - Phone:954-961-1200
Mailing Address - Fax:954-963-0378
Practice Address - Street 1:3850 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6748
Practice Address - Country:US
Practice Address - Phone:954-961-1200
Practice Address - Fax:954-963-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL75865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38381OtherBLUE CROSS BLUE SHIELD
FLK0028Medicare PIN