Provider Demographics
NPI:1578569059
Name:SMOLANSKY, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:SMOLANSKY
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 1:8787 BRYAN DAIRY RD
Mailing Address - Street 2:STE 281
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1258
Mailing Address - Country:US
Mailing Address - Phone:727-320-9100
Mailing Address - Fax:727-320-8100
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:STE 281
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1258
Practice Address - Country:US
Practice Address - Phone:727-320-9100
Practice Address - Fax:727-320-8100
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME31660208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15429AMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID
FLD85115Medicare UPIN