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General NPI Number Information
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NPI Number | 1093336943
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Entity Type | Individual
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Provider Name | DONALD BROCK SMITH DO
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Gender | Male
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 8701 WATERTOWN PLANK RD
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City | MILWAUKEE
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State | WI
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Zip | 53226-3548
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Country | US
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Telephone | 414-955-4575
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 WATERTOWN PLANK RD
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City | MILWAUKEE
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State | WI
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Zip | 53226-3548
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 7387
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 81799-21
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License Number State | WI
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