Provider Demographics
NPI:1114338340
Name:CHRISTOPHER ANTHONY SMITH, MD, LLC
Entity Type:Organization
Organization Name:CHRISTOPHER ANTHONY SMITH, MD, LLC
Other - Org Name:FLORIDA LYMPHEDEMA AND WOUND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-257-7788
Mailing Address - Street 1:14837 ELLINGSWORTH LN
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5673
Mailing Address - Country:US
Mailing Address - Phone:347-257-7788
Mailing Address - Fax:
Practice Address - Street 1:616 E ALTAMONTE DR STE 204
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4810
Practice Address - Country:US
Practice Address - Phone:727-459-3235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009152500Medicaid