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General NPI Number Information
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NPI Number | 1134462146
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Entity Type | Organization
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Legal Business Name | SMITH PLASTIC SURGERY
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 16 OKATIE CENTER BLVD S STE 101
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City | OKATIE
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State | SC
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Zip | 29909-7535
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Country | US
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Telephone | 843-705-8940
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Fax | 843-705-6816
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Provider Business Mailing Address
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Address Line | 16 OKATIE CENTER BLVD S STE 101
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City | OKATIE
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State | SC
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Zip | 29909-7535
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Country | US
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Telephone | 843-705-8940
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Fax | 843-705-6816
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENDAN EDWARD SMITH
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Credential | MD
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Telephone | 843-705-8940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 22095
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License Number State | SC
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