Provider Demographics
NPI:1851376552
Name:JOSEPH, SMITH (DO)
Entity Type:Individual
Prefix:DR
First Name:SMITH
Middle Name:
Last Name:JOSEPH
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 1:13377 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4134
Mailing Address - Country:US
Mailing Address - Phone:305-893-8306
Mailing Address - Fax:305-893-8354
Practice Address - Street 1:13377 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4134
Practice Address - Country:US
Practice Address - Phone:305-893-8306
Practice Address - Fax:305-893-8354
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262244100Medicaid
FL262244100Medicaid
FL06009ZMedicare ID - Type UnspecifiedOSTEOPATHIC DOCTOR