Active NPI
Kevin B Smith, D.O.
- Surgery Physician
- Jacksonville, FL
National Provider Identifier
1902140536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 20120223206
- Practice address
- 2080 Child Street
Jacksonville, FL 32214-5000 - Phone
- (904) 542-7300
- NPI assigned
- Nov 20, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 20120223206 | MO | Primary |
Addresses
Primary practice location
2080 Child Street
Jacksonville, FL 32214-5000
Mailing address
2080 Child Street
Jacksonville, FL 32214-5000
Other practice location 1
200 West Mercy Circle
Camp Pendleton, CA 92055
Phone (760) 725-1356
Other practice location 2
Hospital Americano, Base Naval de Rota
Apartado de Correos 33
Rota, Cadiz 11530
ES
Phone (314) 727-3742
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20120223206 | MO | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719273600000",
"number": "1902140536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2080 CHILD STREET",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322145000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2080 CHILD STREET",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322145000",
"telephone_number": "904-542-7300"
}
],
"practiceLocations": [
{
"address_1": "200 West Mercy Circle",
"address_purpose": "LOCATION",
"city": "Camp Pendleton",
"state": "CA",
"postal_code": "92055",
"country_code": "US",
"telephone_number": "760-725-1356",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "Hospital Americano, Base Naval de Rota",
"address_2": "Apartado de Correos 33",
"address_purpose": "LOCATION",
"city": "Rota",
"state": "Cadiz",
"postal_code": "11530",
"country_code": "ES",
"telephone_number": "314-727-3742",
"country_name": "Spain",
"address_type": "FGN"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "KEVIN",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-20",
"last_updated": "2024-06-25",
"certification_date": "2024-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MO",
"license": "20120223206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.