Provider Demographics
NPI:1851351407
Name:SMITH, CATHERINE S (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:S
Last Name:SMITH
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 1:713 E MARION AVE STE 133
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3868
Mailing Address - Country:US
Mailing Address - Phone:941-833-1777
Mailing Address - Fax:941-347-8544
Practice Address - Street 1:713 E MARION AVE STE 133
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3868
Practice Address - Country:US
Practice Address - Phone:941-833-1777
Practice Address - Fax:941-347-8544
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225426207Y00000X
FLME138387207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010148987Medicaid
G93173Medicare UPIN
VA010148987Medicaid