Provider Demographics
NPI:1467445338
Name:SMITH, JOHN ORSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ORSON
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 1:2633 CENTENNIAL BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0585
Mailing Address - Country:US
Mailing Address - Phone:850-431-5474
Mailing Address - Fax:850-431-4794
Practice Address - Street 1:2633 CENTENNIAL BLVD
Practice Address - Street 2:STE 100
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0585
Practice Address - Country:US
Practice Address - Phone:850-431-5474
Practice Address - Fax:850-431-4794
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME9938207R00000X
GA007898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000OtherSOUTHCARE
FL00000OtherHUMANA CHOICE CARE
FL00000OtherNOVA NET
GA00055646AMedicaid
FL37079OtherBCBS
FL00000OtherVISTA
GA00000OtherBEECH STREET/CAPP CARE
FL00000OtherHUMANA/CHOICE CARE
FL043511200Medicaid
FL00000OtherUNITED HEALTH CARE
FL00000OtherSOUTHCARE
FL37079VMedicare Oscar/Certification