Provider Demographics
NPI:1619941440
Name:SMITH, YALE R (MD)
Entity Type:Individual
Prefix:DR
First Name:YALE
Middle Name:R
Last Name:SMITH
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 1:7000 SPYGLASS CT STE 300
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7948
Mailing Address - Country:US
Mailing Address - Phone:321-421-7111
Mailing Address - Fax:321-421-7157
Practice Address - Street 1:7000 SPYGLASS CT STE 300
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-7948
Practice Address - Country:US
Practice Address - Phone:321-421-7111
Practice Address - Fax:321-421-7157
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36316207L00000X
TN27966207L00000X
KY32260207L00000X
GA037909207L00000X
AL18112207L00000X
FLME80599207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259242800Medicaid
FL35767OtherBSFL
FL35767OtherBSFL
FL35767VMedicare ID - Type Unspecified
KYK144400Medicare PIN