Individual
SUSAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
20 W KALEY ST, ORLANDO, FL 32806-2931
(407) 423-2581
(407) 849-6470
Mailing address
20 W KALEY ST, ORLANDO, FL 32806-2931
(407) 423-2581
(407) 849-6470
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
ME70923
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME70923
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250045100
—
FL
01
—
300067508
RR MEDICARE
FL
01
—
31502
BCBS OF FLORIDA
FL
Enumeration date
07/08/2005
Last updated
08/22/2016
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