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Organization
RENALDAS ALGIRDAS SMIDTAS
Active
Organization
RENALDAS ALGIRDAS SMIDTAS
Active
Parent organization
RENALDAS SMIDTAS MD
Other names
RENALDAS SMIDTAS MD
Organization subpart
Yes
Provider details
NPI number
Legal business name
RENALDAS SMIDTAS MD
Authorized official
RENALDAS ALGIRDAS SMIDTAS MD (OWNER)
(386) 362-5840
Entity
Organization
Contact information
Practice address
1437 N OHIO AVE, LIVE OAK, FL 32064-4817
(386) 362-5840
Mailing address
1437 N OHIO AVE, LIVE OAK, FL 32064-4817
(386) 362-5840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME0069486
FL
207R00000X
Internal Medicine Physician
Primary
ME0069486
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103986
AVMED
FL
01
—
110212209
RAILROAD MEDICARE GA
GA
01
—
27984A
BCBS
FL
05
—
378783401
—
FL
Enumeration date
12/13/2007
Last updated
01/23/2014
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