Provider Demographics
NPI:1639121387
Name:SMITH, ERIC S (PA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:10225 ULMERTON RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3538
Mailing Address - Country:US
Mailing Address - Phone:727-581-4849
Mailing Address - Fax:
Practice Address - Street 1:10225 ULMERTON RD
Practice Address - Street 2:1A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3538
Practice Address - Country:US
Practice Address - Phone:727-585-7408
Practice Address - Fax:727-585-3483
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101685363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical