MEDICARE: MR. MATTHEW RYAN SMITH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9107760	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144412362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW RYAN SMITH PA-C

Provider Business Mailing Address
First Line	:	2920 BAYSHORE VISTA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-5510
Country	:	US
Telephone Number	:	813-787-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	21756 STATE ROAD 54 STE 102A
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-2905
Country	:	US
Telephone Number	:	813-493-4093
Fax Number	:	656-444-7252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2007
Last Update Date	:	10/09/2025

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Directions to “ MR. MATTHEW RYAN SMITH PA-C” Practice Location

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