Provider Demographics
NPI:1083657498
Name:SMITH, DENA J (DO)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-7619
Mailing Address - Fax:850-416-7753
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:SHMG HOSPITALIST
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-416-7619
Practice Address - Fax:850-416-7753
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO2365207R00000X
TNDO1696208M00000X
FLOS13798208M00000X
TNMD1696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0167389-00Medicaid
TN3319361Medicaid
TN103I117669Medicare PIN
TN3319361Medicaid
TN3319361Medicare UPIN