Healthcare Provider Details

I. General information

NPI: 1235635053
Provider Name (Legal Business Name): BRENT JERALD SMITH JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E SOUTH BLVD STE 714
MONTGOMERY AL
36116-2001
US

IV. Provider business mailing address

3901 RAINBOW BLVD # MS 2027
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 800-889-8610
  • Fax:
Mailing address:
  • Phone: 913-588-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.48715
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: