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Individual

RUSSELL BURTON SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3901 UNIVERSITY BLVD S STE 112, JACKSONVILLE, FL 32216-4312
(904) 486-5466
Mailing address
3901 UNIVERSITY BLVD S STE 112, JACKSONVILLE, FL 32216-4312
(904) 486-5466

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
24197
NE
207Y00000X
Otolaryngology Physician
Primary
ME134346
FL
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
ME134346
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0212142
IA
05
10025044400
NE
05
1134112261
IA
01
19770
WELLMARK BCBS
IA
05
47078557504
NE
Enumeration date
08/24/2005
Last updated
02/12/2025
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