Healthcare Provider Details

I. General information

NPI: 1639456346
Provider Name (Legal Business Name): BRYCE COREY SMITHSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 OWENS ST FL 3
SAN FRANCISCO CA
94158-2261
US

IV. Provider business mailing address

222 ALEXANDER ST 4TH FLOOR
ROCHESTER NY
14607-4039
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-2200
  • Fax:
Mailing address:
  • Phone: 585-922-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA116467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: