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General NPI Number Information
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NPI Number | 1104961994
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Entity Type | Individual
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Provider Name | KENT SMILLIE MD
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 787 37TH ST STE E200
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City | VERO BEACH
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State | FL
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Zip | 32960-7306
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Country | US
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Telephone | 772-978-7808
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Fax | 772-978-9320
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Provider Business Mailing Address
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Address Line | 787 37TH ST STE E200
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City | VERO BEACH
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State | FL
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Zip | 32960-7306
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Country | US
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Telephone | 772-978-7808
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Fax | 772-978-9320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD00042627
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01068319A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101249094
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD20796
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License Number State | ME
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME130147
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License Number State | FL
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