Healthcare Provider Details

I. General information

NPI: 1780846691
Provider Name (Legal Business Name): EARL ARTHUR SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5124 N ARMENIA AVE
TAMPA FL
33603-1406
US

IV. Provider business mailing address

5124 N ARMENIA AVE
TAMPA FL
33603-1406
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-5716
  • Fax: 813-877-4890
Mailing address:
  • Phone: 813-879-5716
  • Fax: 813-877-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME17458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: