MEDICARE: MRS. KEISHA SMITH-READ M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208VP0014X	Interventional Pain Medicine Physician	ME123456	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538485404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEISHA SMITH-READ M.D.

Provider Business Mailing Address
First Line	:	3599 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4252
Country	:	US
Telephone Number	:	904-345-7776
Fax Number	:	904-345-7772

Provider Business Practice Location Address
First Line	:	3720 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3814
Country	:	US
Telephone Number	:	904-399-1623
Fax Number	:	904-399-1624

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

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	12/22/2020

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