Healthcare Provider Details

I. General information

NPI: 1619166261
Provider Name (Legal Business Name): SCOTT ERIC GOLDSMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13837 CIRCA CROSSING DR SUITE 110
LITHIA FL
33547-3354
US

IV. Provider business mailing address

13837 CIRCA CROSSING DRIVE
LITHIA FL
33547
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2663
  • Fax: 813-441-7161
Mailing address:
  • Phone: 813-684-2663
  • Fax: 813-658-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME100084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: