Provider Demographics
NPI:1497710313
Name:SMITH, JOHN-STEWART MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN-STEWART
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:14088 ALABAMA ST
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-1036
Mailing Address - Country:US
Mailing Address - Phone:850-675-4546
Mailing Address - Fax:850-675-4548
Practice Address - Street 1:14088 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1036
Practice Address - Country:US
Practice Address - Phone:850-675-4546
Practice Address - Fax:850-675-4548
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01512OtherBCBS OF FLORIDA
FL2357174OtherCIGNA INTERNATIONAL
FL2553182OtherUNITED HEALTHCARE
FL2553182OtherUNITED HEALTCHARE
FL660022100Medicaid
FL7839652OtherAETNA US HEALTHCARE
FLP00368813OtherRAILROAD MEDICARE
FL01512OtherHEALTH 1ST NETWORK, INC.
FL21333OtherBLUE MEDICARE ADVANTAGE
FL2553182OtherDEFINITY HEALTH CLAIMS
FL660022102Medicaid
FL01512OtherPREFERRED PATIENT CARE
FL01512OtherADVANTAGE 65
FL7839652OtherAETNA GLOBAL BENEFITS
FLI39377OtherVISTA
FLW560OtherWELLCARE
AL541900106OtherALACAID
FL7839652OtherAETNA
AL009996365OtherALACAID
FL2357174OtherCIGNA HEALTHCARE
FL272533900Medicaid
FL21333OtherBCBS OF FLORIDA
AL59180291OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
FL593216460A06OtherMEDICAL MUTUAL
FL01512OtherHEALTH 1ST NETWORK, INC.
FL21333OtherBLUE MEDICARE ADVANTAGE
FL660022102Medicaid