Provider Demographics
NPI:1427053057
Name:SMOAK, KIMBERLY GINSBERG (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:GINSBERG
Last Name:SMOAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:10141 BIG BEND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7419
Practice Address - Country:US
Practice Address - Phone:813-643-8300
Practice Address - Fax:813-443-8133
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265797000Medicaid
FL51286Medicare PIN