Provider Demographics
NPI:1902061401
Name:SMART, VALERIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:C
Last Name:SMART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:C
Other - Last Name:SMART-WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6371 PRESIDENTIAL CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3544
Mailing Address - Country:US
Mailing Address - Phone:239-277-7747
Mailing Address - Fax:239-277-7097
Practice Address - Street 1:6371 PRESIDENTIAL CT
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3544
Practice Address - Country:US
Practice Address - Phone:239-277-7747
Practice Address - Fax:239-277-7097
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001295400Medicaid
F32037Medicare UPIN
FL001295400Medicaid