Provider Demographics
NPI:1285632828
Name:SMITH, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
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:PO BOX 198898
Mailing Address - Street 2:UNIVERSITY SPECIALTY CLINICS - SURGERY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8898
Mailing Address - Country:US
Mailing Address - Phone:803-545-5800
Mailing Address - Fax:803-929-0492
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-6839
Practice Address - Country:US
Practice Address - Phone:352-265-0761
Practice Address - Fax:352-265-0190
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04198812086S0127X
PAMD4416172086S0127X
SC350122086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA93951955OtherMEDICARE PTAN
SC350122Medicaid
KS100167800AMedicaid
FL014447600Medicaid
PA1025474900001Medicaid
FL014447600Medicaid
PA1025474900001Medicaid