Individual
MR. BRADFORD SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
650 REED CANAL RD, SOUTH DAYTONA, FL 32119-3230
(386) 310-7868
Mailing address
109 N PAUL REVERE DR, DAYTONA BEACH, FL 32119-1484
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
OTA10222
FL
Other
Enumeration date
05/01/2012
Last updated
05/01/2012
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