Provider Demographics
NPI:1861494262
Name:SMITH, BRUCE P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-799-0042
Practice Address - Street 1:9555 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2562
Practice Address - Country:US
Practice Address - Phone:727-393-5428
Practice Address - Fax:727-399-9037
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2015-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME18523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78253OtherBCBS FL
FL78253UMedicare PIN
FL78253VMedicare PIN
FL78253Medicare PIN
FL78253OtherBCBS FL
FL78253WMedicare PIN