Provider Demographics
NPI:1174048433
Name:SMITH, ROBERT TERRY (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TERRY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 SEAGRAPE WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-4862
Mailing Address - Country:US
Mailing Address - Phone:305-607-2586
Mailing Address - Fax:
Practice Address - Street 1:1530 SEAGRAPE WAY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-4862
Practice Address - Country:US
Practice Address - Phone:305-607-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine