Provider Demographics
NPI:1386737955
Name:SMITH, JAMES W (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4900 BAYOU BOULEVARD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:5147 NORTH 9TH AVENUE
Practice Address - Street 2:SUITE 311
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-477-2597
Practice Address - Fax:850-478-7941
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0038076207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL008202700Medicaid
AL059075508OtherBCBS OF ALABAMA
100000146OtherRAILROAD MEDICARE
6832173OtherCIGNA
Z016OtherHEALTH OPTIONS
000289901002OtherUNITED HEALTH CARE
4647812OtherAETNA
FL17497OtherBCBS OF FLORIDA
FL065335700Medicaid
FL17497OtherBCBS OF FLORIDA
FL065335700Medicaid