Provider Demographics
NPI:1427008226
Name:SMITH, CARLOS IGNACIO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:IGNACIO
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 1:50 BARRACUDA LN
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-3733
Mailing Address - Country:US
Mailing Address - Phone:305-367-2600
Mailing Address - Fax:305-367-4573
Practice Address - Street 1:50 BARRACUDA LN
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-3733
Practice Address - Country:US
Practice Address - Phone:305-367-2600
Practice Address - Fax:305-367-4573
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBS7810559OtherBLUECROSS BLUESHEILD
FL2125480 00Medicaid
FLH76864Medicare UPIN
FL2125480 00Medicaid