Provider Demographics
NPI:1508093154
Name:PEZZOTTI SMITH, REYNALDO (MD)
Entity type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:
Last Name:PEZZOTTI SMITH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 SEAFARER DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-3457
Mailing Address - Country:US
Mailing Address - Phone:407-820-7079
Mailing Address - Fax:787-961-9447
Practice Address - Street 1:3822 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8148
Practice Address - Country:US
Practice Address - Phone:239-900-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17615207QA0505X
FL1037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine