Individual
DIANA MARIE DECOTIS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
928 MAR WALT DR STE 201, FORT WALTON BEACH, FL 32547-6706
(850) 315-8360
(503) 154-2628
Mailing address
928 MAR WALT DR STE 201, FORT WALTON BEACH, FL 32547-6706
(850) 315-8360
(503) 154-2628
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME11588
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009296600
—
FL
Enumeration date
07/07/2009
Last updated
02/08/2022
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