MEDICARE: DR. BRUCE P. SMITH M.D.

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	207R00000X	Internal Medicine Physician	ME18523	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78253	OTHER	FL	BCBS FL

General Provider Information

NPI Number	:	1861494262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE P. SMITH M.D.

Provider Business Mailing Address
First Line	:	14690 SPRING HILL DR
Second Line	:	SUITE 101
City	:	SPRING HILL
State	:	FL
Zip	:	34609-8102
Country	:	US
Telephone Number	:	352-799-0046
Fax Number	:	352-799-0042

Provider Business Practice Location Address
First Line	:	9555 SEMINOLE BLVD
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-2562
Country	:	US
Telephone Number	:	727-393-5428
Fax Number	:	727-399-9037

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	05/22/2015

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