MEDICARE: NORAH MARIA SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME81199	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01309647	OTHER	FL	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	524974	OTHER	FL	WELLCARE
4	51662	OTHER	FL	BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396719506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORAH MARIA SMITH MD

Provider Business Mailing Address
First Line	:	900 S PINE ISLAND RD STE 800
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3923
Country	:	US
Telephone Number	:	863-293-2144
Fax Number	:	863-293-3732

Provider Business Practice Location Address
First Line	:	550 POPE AVE NW # 100
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4679
Country	:	US
Telephone Number	:	863-293-2144
Fax Number	:	863-293-3732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/27/2021

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Directions to “ NORAH MARIA SMITH MD” Practice Location

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