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General NPI Number Information
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NPI Number | 1053704791
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Entity Type | Organization
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Legal Business Name | ROBERT J. SMITH, M.D.
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 2425 S PARK AVE
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City | SANFORD
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State | FL
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Zip | 32771-4419
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Country | US
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Telephone | 407-321-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 S PARK AVE
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City | SANFORD
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State | FL
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Zip | 32771-4419
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Country | US
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Telephone | 407-321-4200
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | ROBERT JOHN SMITH
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Credential | M.D.
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Telephone | 407-321-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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