Individual
TODD SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1625 SE 3RD AVE, SUITE 300, FORT LAUDERDALE, FL 33316-2521
(954) 355-4665
(954) 355-4881
Mailing address
1608 SE 3RD AVE, THIRD FLOOR PBO, FORT LAUDERDALE, FL 33316-2564
(954) 355-4665
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
1003
WI
363AS0400X
Surgical Physician Assistant
Primary
PA9108182
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015493500
—
FL
Enumeration date
10/02/2014
Last updated
10/20/2015
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