Provider Demographics
NPI:1891931051
Name:SMITH, CHRISTOPHER JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2450 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5110
Mailing Address - Country:US
Mailing Address - Phone:386-615-4029
Mailing Address - Fax:386-231-3919
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:SUITE 503
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-231-3911
Practice Address - Fax:386-231-3919
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2023-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME103346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME103346OtherLICENSE