Healthcare Provider Details

I. General information

NPI: 1285632828
Provider Name (Legal Business Name): ROBERT S. SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-6839
US

IV. Provider business mailing address

PO BOX 198898 UNIVERSITY SPECIALTY CLINICS - SURGERY
ATLANTA GA
30384-8898
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0761
  • Fax: 352-265-0190
Mailing address:
  • Phone: 803-545-5800
  • Fax: 803-929-0492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number0419881
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD441617
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number35012
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: