Provider Demographics
NPI:1639162225
Name:SMITH, PATRICK A (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:SMITH
Suffix:
Gender:
Credentials:MD
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 112019
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0134
Mailing Address - Country:US
Mailing Address - Phone:239-624-1700
Mailing Address - Fax:239-624-0311
Practice Address - Street 1:11190 HEALTH PARK BLVD STE 2102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5729
Practice Address - Country:US
Practice Address - Phone:239-624-1700
Practice Address - Fax:239-624-0311
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163665207XX0005X
MOR9F75207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81Y01OtherBCBS
FL124543300Medicaid
MOA12691Medicare UPIN