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General NPI Number Information
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NPI Number | 1598144917
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Entity Type | Individual
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Provider Name | BRIAN SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 12277 DE PAUL DR STE 100
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City | BRIDGETON
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State | MO
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Zip | 63044-2577
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Country | US
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Telephone | 314-209-5142
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 955534
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City | SAINT LOUIS
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State | MO
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Zip | 63195-5534
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.134016
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 2021011406
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License Number State | MO
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