MEDICARE: DR. EDWARD W.P. 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	207N00000X	Dermatology Physician	ME0026592	FL

General Provider Information

NPI Number	:	1467423533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD W.P. SMITH MD

Provider Business Mailing Address
First Line	:	4479 BAYMEADOWS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4716
Country	:	US
Telephone Number	:	904-731-8300
Fax Number	:	904-737-7901

Provider Business Practice Location Address
First Line	:	4479 BAYMEADOWS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4716
Country	:	US
Telephone Number	:	904-731-8300
Fax Number	:	904-737-7901

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/06/2010

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