Healthcare Provider Details

I. General information

NPI: 1891931051
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

IV. Provider business mailing address

2450 MASON AVE
DAYTONA BEACH FL
32114-5110
US

V. Phone/Fax

Practice location:
  • Phone: 386-615-4029
  • Fax: 386-676-7193
Mailing address:
  • Phone: 386-615-4029
  • Fax: 386-676-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME103346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: