Provider Demographics
NPI:1588081202
Name:ERICA SMITHBERGER M.D., P.L.
Entity type:Organization
Organization Name:ERICA SMITHBERGER M.D., P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-752-0757
Mailing Address - Street 1:13207 BURNES LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-1825
Mailing Address - Country:US
Mailing Address - Phone:813-752-0757
Mailing Address - Fax:
Practice Address - Street 1:2010 THONOTOSASSA RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2941
Practice Address - Country:US
Practice Address - Phone:813-752-0757
Practice Address - Fax:813-752-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100370207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184889529OtherINDIVIDUAL NPI
FLBQ6062OtherMEDICARE PTAN