Provider Demographics
NPI:1851756852
Name:SMITH, MICHELLE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3700 CREIGHTON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4680
Mailing Address - Country:US
Mailing Address - Phone:850-473-1441
Mailing Address - Fax:850-473-1442
Practice Address - Street 1:3700 CREIGHTON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-4680
Practice Address - Country:US
Practice Address - Phone:850-473-1441
Practice Address - Fax:850-473-1442
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME84049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine