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General NPI Number Information
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NPI Number | 1356519128
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Entity Type | Organization
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Legal Business Name | TIM M SMITH, M.D.
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 100 DOCTORS DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-7608
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Country | US
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Telephone | 850-763-3722
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Fax | 850-785-7393
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Provider Business Mailing Address
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Address Line | 100 DOCTORS DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-7608
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Country | US
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Telephone | 850-763-3722
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Fax | 850-785-7393
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIM M SMITH JR.
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Credential | M.D.
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Telephone | 850-763-3722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME8816
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License Number State | FL
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