Provider Demographics
NPI:1982779856
Name:SMITH, LEE DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15654
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-5654
Mailing Address - Country:US
Mailing Address - Phone:727-789-4556
Mailing Address - Fax:813-925-1435
Practice Address - Street 1:2451 N MCMULLEN BOOTH RD
Practice Address - Street 2:#206
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1356
Practice Address - Country:US
Practice Address - Phone:727-789-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1914213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029712700Medicaid
FL029712700Medicaid
FLT85370Medicare UPIN