Healthcare Provider Details

I. General information

NPI: 1811719339
Provider Name (Legal Business Name): IRVING HADDEN SMITH III III RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 S DIXIE HWY STE 4
ST AUGUSTINE FL
32084-4174
US

IV. Provider business mailing address

408 PHEASANT RD
SATSUMA FL
32189-2338
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-0022
  • Fax: 904-508-0536
Mailing address:
  • Phone: 386-916-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRT21336
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT21336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: