MEDICARE: ROBERT GREGORY SMITH MD

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	208200000X	Plastic Surgery Physician	ME 44578	FL

General Provider Information

NPI Number	:	1629281340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GREGORY SMITH MD

Provider Business Mailing Address
First Line	:	150 PROFESSIONAL DRIVE
Second Line	:	SUITE 100
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-7232
Country	:	US
Telephone Number	:	904-285-5571
Fax Number	:	904-285-6957

Provider Business Practice Location Address
First Line	:	150 PROFESSIONAL DRIVE
Second Line	:	SUITE 100
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-7232
Country	:	US
Telephone Number	:	904-285-5571
Fax Number	:	904-285-6957

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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