Healthcare Provider Details

I. General information

NPI: 1639162225
Provider Name (Legal Business Name): PATRICK A SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11190 HEALTH PARK BLVD STE 2102
NAPLES FL
34110-5729
US

IV. Provider business mailing address

PO BOX 112019
NAPLES FL
34108-0134
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-1700
  • Fax: 239-624-0311
Mailing address:
  • Phone: 239-624-1700
  • Fax: 239-624-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME163665
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR9F75
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: