Individual
DR. MARK ANTHONY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4620 N HABANA AVE, SUITE 101, TAMPA, FL 33614-7107
(813) 875-9362
(813) 876-7055
Mailing address
4620 N HABANA AVE, SUITE 101, TAMPA, FL 33614-7107
(813) 875-9362
(813) 876-7055
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME38809
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067400100
—
FL
01
—
161540500
US DEPT OF LABOR
FL
01
—
210647
AVMED
FL
01
—
290005684
RAILROAD MEDICARE
FL
01
—
30549
BCBS
FL
01
—
33614A003
CHAMPUS
FL
Enumeration date
02/17/2006
Last updated
12/12/2010
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