Healthcare Provider Details

I. General information

NPI: 1306465901
Provider Name (Legal Business Name): MARK PHILIP SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 RIBAUT RD STE 101
BEAUFORT SC
29902-5477
US

IV. Provider business mailing address

1076 RIBAUT RD STE 101
BEAUFORT SC
29902-5477
US

V. Phone/Fax

Practice location:
  • Phone: 843-525-0045
  • Fax: 843-525-0826
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number96485
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: