Provider Demographics
NPI:1538452073
Name:LUNDQUIST-SMITH, LAYLA RENEE (MD)
Entity type:Individual
Prefix:
First Name:LAYLA
Middle Name:RENEE
Last Name:LUNDQUIST-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-7567
Mailing Address - Country:US
Mailing Address - Phone:251-368-6960
Mailing Address - Fax:251-368-1378
Practice Address - Street 1:609 E. LAURELL STREET
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502
Practice Address - Country:US
Practice Address - Phone:251-368-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115631207Q00000X
ALMD.41738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012201600Medicaid