Provider Demographics
NPI:1083939789
Name:SMITH, HERBERT GEORGE JR (LPO)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:GEORGE
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4109 LITTLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1715
Mailing Address - Country:US
Mailing Address - Phone:727-645-6978
Mailing Address - Fax:727-807-3331
Practice Address - Street 1:4109 LITTLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1715
Practice Address - Country:US
Practice Address - Phone:727-645-6978
Practice Address - Fax:727-807-3331
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR81222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM000MOtherBCBS
FLM000MOtherBCBS