Healthcare Provider Details

I. General information

NPI: 1588864201
Provider Name (Legal Business Name): KRISTY BREUHL SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTY SHANE BREUHL M.D.

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SW ARCHER RD
GAINESVILLE FL
32608-1136
US

IV. Provider business mailing address

3744 NW 26TH ST
GAINESVILLE FL
32605-2078
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-7999
  • Fax:
Mailing address:
  • Phone: 352-219-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number513630 TRN 9750
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME111429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: