Provider Demographics
NPI:1790867620
Name:SMITH, PETER CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHRISTIAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 LAKEVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-446-7578
Mailing Address - Fax:727-447-1716
Practice Address - Street 1:610 LAKEVIEW ROAD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-446-7578
Practice Address - Fax:727-447-1716
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057479207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064436600Medicaid
FL10895OtherBLUE CROSS BLUE SHIELD
FL6347792OtherCIGNA
FL4673934OtherAETNA
FL990010535OtherRAILROAD MEDICARE
FL064436600Medicaid
FLK0081Medicare PIN
FL6347792OtherCIGNA