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General NPI Number Information
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NPI Number | 1639243983
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Entity Type | Individual
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Provider Name | BRYAN LEONARD SMITH M.D., FACS
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 200 HEALTHCARE WAY
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City | NORTH VENICE
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State | FL
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Zip | 34275-3669
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Country | US
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Telephone | 941-261-2000
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Fax | 941-261-0880
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Provider Business Mailing Address
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Address Line | PO BOX 947407
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City | ATLANTA
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State | GA
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Zip | 30394-7407
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Country | US
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Telephone | 941-917-2600
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Fax | 941-917-7884
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME58340
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License Number State | FL
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