MEDICARE: DR. THEODORE ROBERT SMALL

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	208600000X	Surgery Physician	ME80589	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	:	1992704555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE ROBERT SMALL

Provider Business Mailing Address
First Line	:	2995 DREW ST
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:	727-315-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 MEASE DR
Second Line	:	SUITE 301
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-6605
Country	:	US
Telephone Number	:	727-724-2880
Fax Number	:	727-333-6419

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/05/2025

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Directions to “ DR. THEODORE ROBERT SMALL ” Practice Location

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