Provider Demographics
NPI:1477851053
Name:STEVE W. SMITH M.D., P.A.
Entity Type:Organization
Organization Name:STEVE W. SMITH M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-750-1441
Mailing Address - Street 1:102 SOUTHERN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-1446
Mailing Address - Country:US
Mailing Address - Phone:813-750-1441
Mailing Address - Fax:813-757-6175
Practice Address - Street 1:102 SOUTHERN OAKS DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-1446
Practice Address - Country:US
Practice Address - Phone:813-750-1441
Practice Address - Fax:813-757-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59079261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05821400Medicaid
FL05821400Medicaid
FL11706Medicare PIN