Individual
DR. KELLY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1525 W CYPRESS CREEK RD, FORT LAUDERDALE, FL 33309-1831
(954) 939-5577
Mailing address
1800 SE TIFFANY AVE, PORT ST LUCIE, FL 34952-7521
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME106626
FL
390200000X
Student in an Organized Health Care Education/Training Program
4301087897
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002470500
—
FL
Enumeration date
04/02/2007
Last updated
07/20/2022
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