License Verification

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MICHAEL SMITH

License Number: PA9110665

Data As Of 5/16/2024

Profession
Physician Assistant
License
PA9110665
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
09/14/2017
Address of Record
255 N Lakemont Ave
Suite #207
Rothman Orthopedics
WINTER PARK, FL 32792
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
2325 W. Fairbanks Ave Suite 2
WINTER PARK, FL 32789
Name Relationship Profession License Effective Date
AHMED, ATIF K Supervising Prescribing Practitioner Medical Doctor 149424 05/19/2021
DURFEE, RYAN ANTHONY M D Supervising Prescribing Practitioner Medical Doctor 129229 05/01/2021
HAWKS, MICHAEL ANTHONY Supervising Prescribing Practitioner Medical Doctor 104554 05/01/2021
HENDRIX, TIMOTHY WAYNE Supervising Dispensing Practitioner Medical Doctor 65142 07/19/2022

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 5/16/2024



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** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


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