Individual
FREDERICK RAYMOND SMITH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3945 PINETOP BLVD, TITUSVILLE, FL 32796-3636
(321) 267-5396
Mailing address
3945 PINETOP BLVD, TITUSVILLE, FL 32796-3636
(321) 267-5396
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME 0030862
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048420200
—
FL
Enumeration date
01/23/2009
Last updated
01/23/2009
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