Provider Demographics
NPI:1508868464
Name:SMITH, GREGORY N (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:N
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1325 SAN MARCO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8568
Mailing Address - Country:US
Mailing Address - Phone:904-346-3465
Mailing Address - Fax:904-261-9353
Practice Address - Street 1:1250 S 18TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1902
Practice Address - Country:US
Practice Address - Phone:904-261-8787
Practice Address - Fax:904-261-9353
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME66525207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200029264OtherRAILROAD MEDICARE
FL253374000Medicaid
FL200029264OtherRAILROAD MEDICARE
FL41251XMedicare PIN
FL253374000Medicaid