Provider Demographics
NPI:1063528974
Name:SMITH, JEFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2758
Mailing Address - Country:US
Mailing Address - Phone:386-238-3293
Mailing Address - Fax:
Practice Address - Street 1:320 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2744
Practice Address - Country:US
Practice Address - Phone:386-238-3293
Practice Address - Fax:386-238-3223
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281374200Medicaid
FLP01111523OtherRAILROAD MEDICARE
FL106328974OtherTRICARE
FL42847OtherBCBS
FLAL147XMedicare PIN