Healthcare Provider Details

I. General information

NPI: 1760829147
Provider Name (Legal Business Name): ROBERT DANIEL SMITH II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2013
Last Update Date: 10/06/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NW 34TH TER
GAINESVILLE FL
32607-2434
US

IV. Provider business mailing address

601 NW 34TH TER
GAINESVILLE FL
32607-2433
US

V. Phone/Fax

Practice location:
  • Phone: 304-610-5471
  • Fax:
Mailing address:
  • Phone: 304-610-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME129827
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN18829
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: