Healthcare Provider Details

I. General information

NPI: 1124065826
Provider Name (Legal Business Name): BRUCE W SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 ASBURY ST PATTON PARK MED.CENTER
S HAMILTON MA
01982-1808
US

IV. Provider business mailing address

42 ASBURY ST
S HAMILTON MA
01982-1808
US

V. Phone/Fax

Practice location:
  • Phone: 978-468-4101
  • Fax: 978-468-7067
Mailing address:
  • Phone: 978-468-4101
  • Fax: 978-468-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number70411
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: