Provider Demographics
NPI:1871546515
Name:SMITH, CLEATIOUS DAVID (MD)
Entity type:Individual
Prefix:
First Name:CLEATIOUS
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:14088 ALABAMA ST
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565
Mailing Address - Country:US
Mailing Address - Phone:850-675-4546
Mailing Address - Fax:850-675-4548
Practice Address - Street 1:14088 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565
Practice Address - Country:US
Practice Address - Phone:850-675-4546
Practice Address - Fax:850-675-4548
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME36891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0166758OtherUNITED HEALTHCARE
FL21333OtherBLUE MEDICARE ADVANTAGE
FL57089OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA
FL660022102Medicaid
FL039350900Medicaid
FL1050038OtherCIGNA INTERNATIONAL
FL21333OtherADVANTAGE 65
FL57089OtherHEALTH 1ST NETWORK, INC.
AL59116861OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
FL592014611BOtherHUMANA CLAIMS OFFICE
FLA093OtherHEALTH FIRST NETWORK
FLN146OtherWELLCARE
FL0166758OtherDEFINITY HEALTH CLAIMS
FL593216460A06OtherMEDICAL MUTUAL
AL59024373OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
FL660022100Medicaid
FL0166758OtherUNITED HEALTHCARE OF FLORIDA
FL1050038OtherCIGNA HEALTHCARE
FL5309586OtherAETNA GLOBAL BENEFITS
AL541009001OtherALACAID
FLP00017879OtherRAILROAD MEDICARE
AL000800449OtherALACAID
FL5309586OtherAETNA US HEALTHCARE
FL051128OtherVISTA
FL1871546515OtherPYRAMID CLAIMS
21333OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA
FL5309586OtherAETNA
FL57089OtherPREFERRED PATIENT CARE
FL592014611BOtherHUMANA/EMPLOYERS HEALTH
FL593216460A06OtherMEDICAL MUTUAL
FL5309586OtherAETNA
FL660022100Medicaid