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General NPI Number Information
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NPI Number | 1457568685
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Entity Type | Individual
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Provider Name | JUSTIN SMILEY DO
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 43 CASSINE WAY STE 102
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-0457
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Country | US
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Telephone | 850-231-1919
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Fax | 850-231-1918
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Provider Business Mailing Address
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Address Line | 43 CASSINE WAY STE 102
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-0457
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Country | US
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Telephone | 850-231-1919
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Fax | 850-231-1918
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 44001
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS12346
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License Number State | FL
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