Provider Demographics
NPI:1114086451
Name:SMITH, ALAN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
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 1:15517 CARRILLON ESTATES BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3303
Mailing Address - Country:US
Mailing Address - Phone:813-963-3681
Mailing Address - Fax:813-262-2943
Practice Address - Street 1:15517 CARRILLON ESTATES BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3303
Practice Address - Country:US
Practice Address - Phone:813-963-3681
Practice Address - Fax:813-262-2943
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35632207R00000X
GA57187207R00000X
HI14859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine