Provider Demographics
NPI:1588688543
Name:SMITH, MATTHEW H (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:H
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 1:1301 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3120
Mailing Address - Country:US
Mailing Address - Phone:727-584-7706
Mailing Address - Fax:727-585-4807
Practice Address - Street 1:1301 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3120
Practice Address - Country:US
Practice Address - Phone:727-584-7706
Practice Address - Fax:727-585-4807
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA042340207R00000X, 207RC0200X, 207RP1001X
FLME111177207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14H4COtherBCBS
NJ2221004Medicaid
FL004108600Medicaid
FL353081OtherUNITED
FL1126783OtherCIGNA
FL4288540OtherAETNA
FL1087650OtherCAREPLUS
FLFK543ZMedicare PIN
FL1087650OtherCAREPLUS
FL353081OtherUNITED