1932171055 NPI number — SHARON SMITH-THOMAS MD

Table of content: SHARON SMITH-THOMAS MD (NPI 1932171055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932171055 NPI number — SHARON SMITH-THOMAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH-THOMAS
Provider First Name:
SHARON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932171055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 W PALMETTO PARK RD STE 102A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33433-3455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-425-9251
Provider Business Mailing Address Fax Number:
561-300-1569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 W PALMETTO PARK RD STE 102A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33433-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-425-9251
Provider Business Practice Location Address Fax Number:
561-300-1569
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  ME107067 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: MD2004-0827 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202000066 . This is a "PRESBYTERIAN HEALTH/SALUD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 10019725 . This is a "LOVELACE HEALTH/SALUD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 00551 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 60053771 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 952756 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: QMYPR0068275 . This is a "MOLINA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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