Provider Demographics
NPI:1275504144
Name:SMITH, JAMES RONALD II (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RONALD
Last Name:SMITH
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:RONALD
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 OSPREY BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-3308
Mailing Address - Country:US
Mailing Address - Phone:863-519-1440
Mailing Address - Fax:863-519-1432
Practice Address - Street 1:2200 OSPREY BLVD
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3308
Practice Address - Country:US
Practice Address - Phone:863-519-1440
Practice Address - Fax:863-519-1432
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87202207P00000X
FLME88216207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB06265Medicare UPIN