Provider Demographics
NPI:1639103559
Name:TEMKIN-SMITH, STACY (DO)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:TEMKIN-SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 MEDICAL DR
Mailing Address - Street 2:REHABILITATION CENTER
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4617
Mailing Address - Country:US
Mailing Address - Phone:850-431-5440
Mailing Address - Fax:850-431-6322
Practice Address - Street 1:1609 MEDICAL DR
Practice Address - Street 2:REHABILITATION CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4617
Practice Address - Country:US
Practice Address - Phone:850-431-5440
Practice Address - Fax:850-431-6322
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18836207P00000X
FLOS9742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660147200Medicaid
FLAI344YMedicare Oscar/Certification