Healthcare Provider Details

I. General information

NPI: 1639198468
Provider Name (Legal Business Name): DANNY SMITH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BARRS ST
JACKSONVILLE FL
32204-4704
US

IV. Provider business mailing address

BPX PO
ORLANDO FL
32886-0001
US

V. Phone/Fax

Practice location:
  • Phone: 904-346-5426
  • Fax: 904-346-0113
Mailing address:
  • Phone: 904-396-6620
  • Fax: 904-396-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: