MEDICARE: ROBERT EDWARD SMITH IV

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	237700000X	Hearing Instrument Specialist	AS5661	FL

General Provider Information

NPI Number	:	1710691555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT EDWARD SMITH IV

Provider Business Mailing Address
First Line	:	5020 E BAY DR STE 800
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-5726
Country	:	US
Telephone Number	:	727-330-9676
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 E BAY DR STE 800
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-5726
Country	:	US
Telephone Number	:	727-330-9676
Fax Number	:

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

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	11/03/2023

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