Individual
CHRISTOPHER SHANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5147 N 9TH AVE STE 311, PENSACOLA, FL 32504-8770
(850) 477-2597
(850) 478-7941
Mailing address
4828 N DAVIS HWY, PENSACOLA, FL 32503-2341
(850) 477-8109
(850) 478-2412
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9102127
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009913575
—
AL
01
—
059076677
BCBS OF ALABAMA
AL
05
—
291473500
—
FL
01
—
970030058
RAILROAD MEDICARE
—
Enumeration date
10/05/2006
Last updated
03/27/2018
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