Provider Demographics
NPI:1962647446
Name:SMITH, ADRIANNE PATRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:PATRICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5220 BELFORT RD STE 130
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6018
Mailing Address - Country:US
Mailing Address - Phone:904-446-3781
Mailing Address - Fax:904-446-3032
Practice Address - Street 1:2900 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6958
Practice Address - Country:US
Practice Address - Phone:037-312-2199
Practice Address - Fax:903-731-2246
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2019-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK0209207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128877109Medicaid
TX614038ZHG6OtherMEDICARE