Provider Demographics
NPI:1699758995
Name:SMITH, EDWARD LOUIS (MPAS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LOUIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 W EL PRADO BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8613
Mailing Address - Country:US
Mailing Address - Phone:229-293-3040
Mailing Address - Fax:
Practice Address - Street 1:3812 W EL PRADO BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8613
Practice Address - Country:US
Practice Address - Phone:229-293-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical