Healthcare Provider Details

I. General information

NPI: 1427008226
Provider Name (Legal Business Name): CARLOS IGNACIO SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BARRACUDA LN
KEY LARGO FL
33037-3733
US

IV. Provider business mailing address

50 BARRACUDA LN
KEY LARGO FL
33037-3733
US

V. Phone/Fax

Practice location:
  • Phone: 305-367-2600
  • Fax: 305-367-4573
Mailing address:
  • Phone: 305-367-2600
  • Fax: 305-367-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME85116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: