Provider Demographics
NPI:1073558300
Name:SMITH, STEVEN JAY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAY
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 1:3301 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2329
Mailing Address - Country:US
Mailing Address - Phone:305-289-6420
Mailing Address - Fax:305-743-8684
Practice Address - Street 1:5701 OVERSEAS HWY
Practice Address - Street 2:SUITE 8
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2784
Practice Address - Country:US
Practice Address - Phone:305-743-3511
Practice Address - Fax:305-743-9576
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34785208600000X, 2086S0129X, 208C00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00060772OtherRAILROAD MEDICARE
FL44157OtherBLUE CROSS BLUE SHIELD
FL038196900Medicaid
FL44157YMedicare ID - Type Unspecified
FLD64192Medicare PIN