Provider Demographics
NPI:1215076518
Name:SMITH, SAMUEL GOODALE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GOODALE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 NOBLE FAIRE DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6432
Mailing Address - Country:US
Mailing Address - Phone:813-746-1989
Mailing Address - Fax:
Practice Address - Street 1:307 NOBLE FAIRE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6432
Practice Address - Country:US
Practice Address - Phone:813-746-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT014833207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology