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General NPI Number Information
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NPI Number | 1366438855
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Entity Type | Individual
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Provider Name | STEPHEN E SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 4225 EVANS AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-9311
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Country | US
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Telephone | 239-936-8655
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Fax | 239-936-8683
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Provider Business Mailing Address
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Address Line | 4225 EVANS AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-9311
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Country | US
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Telephone | 239-936-8655
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Fax | 239-936-8683
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME75617
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License Number State | FL
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