Provider Demographics
NPI:1497434534
Name:SMITH, CALEB JAMES
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 CAPTAINS CT
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2984
Mailing Address - Country:US
Mailing Address - Phone:850-572-8835
Mailing Address - Fax:
Practice Address - Street 1:3880 CAPTAINS CT
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-2984
Practice Address - Country:US
Practice Address - Phone:850-572-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program