Provider Demographics
NPI:1447268131
Name:JAMIE R. SMOLEN, MD LLC
Entity type:Organization
Organization Name:JAMIE R. SMOLEN, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SMOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-518-8501
Mailing Address - Street 1:3809 STATE ROAD 64 EAST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208
Mailing Address - Country:US
Mailing Address - Phone:941-748-1848
Mailing Address - Fax:
Practice Address - Street 1:3809 STATE ROAD 64 EAST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-748-1848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME821962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164470449OtherINDIVIDUAL NPI #
FLME82196OtherMEDICAL LICENSE
FLME82196OtherMEDICAL LICENSE
FLBS7565988OtherDEA #
FLB86146Medicare UPIN