Provider Demographics
NPI:1366438855
Name:SMITH, STEPHEN E (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4225 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9311
Mailing Address - Country:US
Mailing Address - Phone:239-936-8655
Mailing Address - Fax:239-936-8683
Practice Address - Street 1:4225 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9311
Practice Address - Country:US
Practice Address - Phone:239-936-8655
Practice Address - Fax:239-936-8683
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME75617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254549702Medicaid
FL43114AMedicare PIN
FLF81810Medicare UPIN