MEDICARE: DR. MATTHEW L SMITH 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	207KA0200X	Allergy Physician	ME98015	FL
2	207Q00000X	Family Medicine Physician	ME98015	FL
3	2080A0000X	Pediatric Adolescent Medicine Physician	ME98015	FL
4	208D00000X	General Practice Physician	ME98015	FL
5	208000000X	Pediatrics Physician	ME98015	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	:	1659361749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW L SMITH M.D.

Provider Business Mailing Address
First Line	:	17011 STATE ROAD 50 STE 103
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-8203
Country	:	US
Telephone Number	:	310-721-3793
Fax Number	:

Provider Business Practice Location Address
First Line	:	17011 STATE ROAD 50 STE 103
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-8203
Country	:	US
Telephone Number	:	310-721-3793
Fax Number	:

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	04/26/2023

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