Healthcare Provider Details

I. General information

NPI: 1689735383
Provider Name (Legal Business Name): JEFFREY B SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 S PINELLAS AVE HELEN ELLIS MEMORIAL HOSPITAL
TARPON SPRINGS FL
34689-3790
US

IV. Provider business mailing address

PO BOX 6647
OZONA FL
34660-6647
US

V. Phone/Fax

Practice location:
  • Phone: 727-942-5113
  • Fax:
Mailing address:
  • Phone: 727-942-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME61414
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME61414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: