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General NPI Number Information
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NPI Number | 1295744639
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Entity Type | Organization
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Legal Business Name | MARK A SMITH MD,P.A.
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10095 BEACH BLVD STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4775
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Country | US
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Telephone | 904-997-2221
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Fax | 904-997-2297
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Provider Business Mailing Address
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Address Line | 10095 BEACH BLVD STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4775
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Country | US
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Telephone | 904-997-2221
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Fax | 904-997-2297
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MARK ANTHONY SMITH
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Credential | M.D.
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Telephone | 904-997-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | ME77870
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License Number State | FL
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