Provider Demographics
NPI:1255568051
Name:SMITH, ADIEL (MD)
Entity type:Individual
Prefix:DR
First Name:ADIEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20900 NE 30TH AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2162
Mailing Address - Country:US
Mailing Address - Phone:786-590-1777
Mailing Address - Fax:786-590-1888
Practice Address - Street 1:20900 NE 30TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2162
Practice Address - Country:US
Practice Address - Phone:786-590-1777
Practice Address - Fax:786-590-1888
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122256207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT195576OtherPENNSYLVANIA LISCENCE