MEDICARE: ARNOLD GRAHAM SMITH, MD PA

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	174400000X	Specialist	ME0039103	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15651	OTHER		BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1386985307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARNOLD GRAHAM SMITH, MD PA

Provider Business Mailing Address
First Line	:	9191 R G SKINNER PKWY
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9655
Country	:	US
Telephone Number	:	904-391-6862
Fax Number	:	904-391-1005

Provider Business Practice Location Address
First Line	:	9191 R G SKINNER PKWY
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9655
Country	:	US
Telephone Number	:	904-391-6862
Fax Number	:	904-391-1005

Authorized Official
Title or Position	:	ADMIN/VP
Name	:	MS. SHANNON GOOSSEN
Credential	:
Telephone Number	:	904-391-6862

Provider Enumeration Date	:	03/15/2013
Last Update Date	:	05/06/2013

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