Healthcare Provider Details

I. General information

NPI: 1871578427
Provider Name (Legal Business Name): PAMELA DEE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD STE 114
EGLIN AFB FL
32542-1302
US

IV. Provider business mailing address

320 HAMAKUA DR
KAILUA HI
96734-3921
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8221
  • Fax:
Mailing address:
  • Phone: 808-261-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA 063353
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberA 063353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: