Provider Demographics
NPI:1346669025
Name:JEAN-SMITH, GERDIE (MD,)
Entity Type:Individual
Prefix:DR
First Name:GERDIE
Middle Name:
Last Name:JEAN-SMITH
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:GERDIE
Other - Middle Name:
Other - Last Name:JEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3450 ROWLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2284
Mailing Address - Country:US
Mailing Address - Phone:941-276-8036
Mailing Address - Fax:941-833-7601
Practice Address - Street 1:3450 ROWLAND DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2284
Practice Address - Country:US
Practice Address - Phone:941-276-8036
Practice Address - Fax:941-833-7601
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50683207Q00000X, 207QG0300X, 390200000X
KYR3520207Q00000X
FLME136348208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK161440OtherMEDICARE
KY7100362060Medicaid