Provider Demographics
NPI:1710691555
Name:SMITH, ROBERT EDWARD IV
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:SMITH
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 E BAY DR STE 800
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-5726
Mailing Address - Country:US
Mailing Address - Phone:727-330-9676
Mailing Address - Fax:
Practice Address - Street 1:5020 E BAY DR STE 800
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-5726
Practice Address - Country:US
Practice Address - Phone:727-330-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5661237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist