Provider Demographics
NPI:1467423533
Name:SMITH, EDWARD WP (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WP
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4479 BAYMEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4716
Mailing Address - Country:US
Mailing Address - Phone:904-731-8300
Mailing Address - Fax:904-737-7901
Practice Address - Street 1:4479 BAYMEADOWS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4716
Practice Address - Country:US
Practice Address - Phone:904-731-8300
Practice Address - Fax:904-737-7901
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0026592207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15526ZMedicare PIN