Provider Demographics
NPI:1194805085
Name:SMITH, ARNOLD GRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:GRAHAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ARNOLD
Other - Middle Name:
Other - Last Name:GRAHAM SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9191 R G SKINNER PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9655
Mailing Address - Country:US
Mailing Address - Phone:904-391-6862
Mailing Address - Fax:904-391-1005
Practice Address - Street 1:9191 R G SKINNER PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9655
Practice Address - Country:US
Practice Address - Phone:904-391-6862
Practice Address - Fax:904-391-1005
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039103207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15651OtherBCBS PROVIDER NUMBER
FL010001690OtherRAILROAD MEDICARE
FL15651OtherBCBS PROVIDER NUMBER
FLD52683Medicare UPIN
FL15651Medicare ID - Type UnspecifiedPROVIDER NUMBER