MEDICARE: DR. RYAN ALAN SMITH D.O.

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	207RC0000X	Cardiovascular Disease Physician	OS15035	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	:	1518100148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN ALAN SMITH D.O.

Provider Business Mailing Address
First Line	:	521 W STATE ROAD 434 STE 308
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5166
Country	:	US
Telephone Number	:	321-841-6444
Fax Number	:	321-842-1955

Provider Business Practice Location Address
First Line	:	521 W STATE ROAD 434 STE 308
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5166
Country	:	US
Telephone Number	:	321-841-6444
Fax Number	:	321-842-1955

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	03/26/2026

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