Provider Demographics
NPI:1669792776
Name:SMITH, ALLESSA ALLISON (MD)
Entity type:Individual
Prefix:MS
First Name:ALLESSA
Middle Name:ALLISON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLESSA
Other - Middle Name:DANIELLE
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:525 BRENT LANE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-471-2221
Mailing Address - Fax:850-471-2245
Practice Address - Street 1:525 BRENT LANE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-471-2221
Practice Address - Fax:850-471-2245
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119638207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD12630400Medicaid