Provider Demographics
NPI:1881659993
Name:SMITH, ASHLEY A
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 522345
Mailing Address - Street 2:
Mailing Address - City:MARATHON SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33052-2345
Mailing Address - Country:US
Mailing Address - Phone:305-743-6299
Mailing Address - Fax:305-743-2921
Practice Address - Street 1:8055 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3228
Practice Address - Country:US
Practice Address - Phone:305-743-6299
Practice Address - Fax:305-743-2921
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00864372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272725100Medicaid
FLP00272087OtherRAILROAD MEDICARE
FL28591OtherBLUE CROSS BLUE SHIELD
FLP00272087OtherRAILROAD MEDICARE
FLB61937Medicare UPIN
FL28591ZMedicare PIN