Provider Demographics
NPI:1033213749
Name:SMITH, RICHARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 METROWEST BLVD STE 104-105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7636
Mailing Address - Country:US
Mailing Address - Phone:407-292-2156
Mailing Address - Fax:866-777-3096
Practice Address - Street 1:6200 METROWEST BLVD STE 104-105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7636
Practice Address - Country:US
Practice Address - Phone:407-292-2156
Practice Address - Fax:866-777-3096
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2079653OtherAETNA PPO
FL373793400Medicaid
FL18423OtherBCBS-FL
FLF48974Medicare UPIN
FL373793400Medicaid