MEDICARE: JEFFREY T. SMITH, PH.D., P.A.

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	103TC0700X	Clinical Psychologist	PY4531	FL

General Provider Information

NPI Number	:	1477854156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY T. SMITH, PH.D., P.A.

Provider Business Mailing Address
First Line	:	1905 TYRONE BLVD N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-4841
Country	:	US
Telephone Number	:	727-347-3284
Fax Number	:	727-347-4472

Provider Business Practice Location Address
First Line	:	1905 TYRONE BLVD N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-4841
Country	:	US
Telephone Number	:	727-347-3284
Fax Number	:	727-347-4472

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY THORNTON SMITH
Credential	:	PH.D.
Telephone Number	:	727-347-3284

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	11/10/2010

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