Healthcare Provider Details

I. General information

NPI: 1790064863
Provider Name (Legal Business Name): CHRISTOPHER A SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 LAKE UNDERHILL RD
ORLANDO FL
32822-8223
US

IV. Provider business mailing address

7620 LAKE UNDERHILL RD
ORLANDO FL
32822-8223
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-0692
  • Fax: 321-235-0694
Mailing address:
  • Phone: 321-235-0692
  • Fax: 321-235-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME116422
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME116422
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME116422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: