Healthcare Provider Details

I. General information

NPI: 1578592895
Provider Name (Legal Business Name): BRYAN MATTHEW SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E POPLAR ST
CLARKSVILLE AR
72830-4419
US

IV. Provider business mailing address

1100 E POPLAR ST
CLARKSVILLE AR
72830-4419
US

V. Phone/Fax

Practice location:
  • Phone: 479-754-5393
  • Fax:
Mailing address:
  • Phone:
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125.062786
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA156007
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-12426
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3952
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: