=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154367522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEIL E SMERLING MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2006
-----------------------------------------------------
Last Update Date | 11/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18659 TAMIAMI TRL STE A
-----------------------------------------------------
City | NORTH PORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34287-7388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-293-4169
-----------------------------------------------------
Fax | 941-429-3430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2675 WINKLER AVE FL 2
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33901-9342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-429-3416
-----------------------------------------------------
Fax | 941-429-3430
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME141467
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------