Provider Demographics
NPI:1659756112
Name:RICHARD L SMITH MD PA
Entity Type:Organization
Organization Name:RICHARD L SMITH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-650-2063
Mailing Address - Street 1:142 E GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1223
Mailing Address - Country:US
Mailing Address - Phone:407-650-2063
Mailing Address - Fax:407-730-3064
Practice Address - Street 1:142 E GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1223
Practice Address - Country:US
Practice Address - Phone:407-650-2063
Practice Address - Fax:407-730-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies