Provider Demographics
NPI:1053704791
Name:ROBERT J. SMITH, M.D.
Entity type:Organization
Organization Name:ROBERT J. SMITH, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-321-4200
Mailing Address - Street 1:2425 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-4419
Mailing Address - Country:US
Mailing Address - Phone:407-321-4200
Mailing Address - Fax:
Practice Address - Street 1:2425 S PARK AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-4419
Practice Address - Country:US
Practice Address - Phone:407-321-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080104508OtherRR MEDICARE
FL59034OtherBCBSFL
FL59034OtherBCBSFL
FL080104508OtherRR MEDICARE