Healthcare Provider Details

I. General information

NPI: 1215908272
Provider Name (Legal Business Name): BRIAN D. SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N WASHINGTON ST
SHELBY NC
28150-3858
US

IV. Provider business mailing address

808 N WASHINGTON ST
SHELBY NC
28150-3858
US

V. Phone/Fax

Practice location:
  • Phone: 704-480-0008
  • Fax: 704-480-0010
Mailing address:
  • Phone: 704-480-0008
  • Fax: 704-480-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number96-01728
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: