Provider Demographics
NPI:1982787743
Name:SMITH, MARCUS (AP, LAC, MSOM)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:AP, LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CORAL RIDGE DR
Mailing Address - Street 2:#379
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5433
Mailing Address - Country:US
Mailing Address - Phone:954-907-1036
Mailing Address - Fax:
Practice Address - Street 1:2929 N UNIVERSITY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5081
Practice Address - Country:US
Practice Address - Phone:954-907-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1954171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist