Healthcare Provider Details

I. General information

NPI: 1013961960
Provider Name (Legal Business Name): BRIAN F SMART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7416 212TH ST SW
EDMONDS WA
98026-7609
US

IV. Provider business mailing address

1650 S TOPAZ WAY
MERIDIAN ID
83642-4474
US

V. Phone/Fax

Practice location:
  • Phone: 425-245-5800
  • Fax: 855-212-5682
Mailing address:
  • Phone: 208-605-7070
  • Fax: 208-898-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60234830
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: