Provider Demographics
NPI:1730323247
Name:SMITH-DIXON, AMELIA ALICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:ALICIA
Last Name:SMITH-DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ALAFAYA TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4315
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-330-5074
Practice Address - Street 1:5449 S SEMORAN BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1722
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:321-832-1037
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001132100Medicaid
FL001132100Medicaid
FLCB202XMedicare PIN
FLCB202YMedicare PIN