Provider Demographics
NPI:1811938442
Name:SMITH, VICTORIA L (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 KERRY FOREST PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-7803
Mailing Address - Country:US
Mailing Address - Phone:850-907-0097
Mailing Address - Fax:850-325-6013
Practice Address - Street 1:2915 KERRY FOREST PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-7802
Practice Address - Country:US
Practice Address - Phone:850-907-0097
Practice Address - Fax:850-325-6013
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00307759OtherRAIL ROAD
FL256968000Medicaid
FL256968000Medicaid
FLE3155VMedicare PIN