Provider Demographics
NPI:1578725776
Name:SMITH, KIRK M (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4400 BAYOU BLVD
Mailing Address - Street 2:SUITE 23A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2673
Mailing Address - Country:US
Mailing Address - Phone:850-476-5623
Mailing Address - Fax:850-476-1357
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:SUITE 23A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:850-476-5623
Practice Address - Fax:850-476-1357
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME584702086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11601Medicare PIN