Healthcare Provider Details

I. General information

NPI: 1427321587
Provider Name (Legal Business Name): RICHARD L SMITH MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 33RD ST STE 200
ORLANDO FL
32839
US

IV. Provider business mailing address

PO BOX 946776
ATLANTA GA
30394-6776
US

V. Phone/Fax

Practice location:
  • Phone: 407-641-5472
  • Fax:
Mailing address:
  • Phone: 813-549-2134
  • Fax: 813-569-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME0061686
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TRACIE GARI
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 813-549-2134