Decotis Smith, Diana Marie

Decotis Smith, Diana Marie is an sole proprietor health care provider with primary practice located at 928 Mar Walt Dr Ste 201 , Fort Walton Beach FL 32547-6706. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Decotis Smith, Diana Marie can be contacted via phone (850) 315-8360.

Contact Information

Primary practice address
928 Mar Walt Dr Ste 201 Fort Walton Beach FL 32547-6706
Fax: (503) 154-2628
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X ME11588 Florida

Profile Details

NPI number 1104055599
LBN Legal business name Decotis Smith, Diana Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 7th, 2009
Last updated Feb 8th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104055599 NPPES
Florida MEDICAID 009296600

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