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General NPI Number Information
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NPI Number | 1568571263
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Entity Type | Individual
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Provider Name | RENALDAS SMIDTAS MD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 12/23/2013
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Provider Practice Location Address
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Address Line | 413 NW 5TH AVE
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City | JASPER
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State | FL
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Zip | 32052
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Country | US
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Telephone | 386-792-0753
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Fax | 386-792-2412
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Provider Business Mailing Address
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Address Line | 413 NW 5TH AVE
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City | JASPER
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State | FL
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Zip | 32052
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Country | US
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Telephone | 386-792-0753
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Fax | 386-792-2412
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0069486
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License Number State | FL
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