MEDICARE: DR. THOMAS E SMITH PHD

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	1041C0700X	Clinical Social Worker	SW14389	FL

General Provider Information

NPI Number	:	1730614553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS E SMITH PHD

Provider Business Mailing Address
First Line	:	1328 AVONDALE WAY
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32317-8453
Country	:	US
Telephone Number	:	850-321-9661
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 E PARK AVE
Second Line	:	SUITE 1A
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-3446
Country	:	US
Telephone Number	:	850-692-6540
Fax Number	:

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

Provider Enumeration Date	:	04/30/2017
Last Update Date	:	04/30/2017

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