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
Phone: (850) 315-8360
Fax: (503) 154-2628
Website:
Health care specialties
| Specialty | Code | License # | 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 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104055599 | NPPES |
| Florida | MEDICAID | 009296600 |
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