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General NPI Number Information
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NPI Number | 1649504366
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Entity Type | Organization
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Legal Business Name | BRADLEY SMITH MD PC
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 1329 SPANOS CT STE C1
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City | MODESTO
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State | CA
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Zip | 95355-2806
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Country | US
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Telephone | 209-451-2377
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Fax | 209-433-0441
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Provider Business Mailing Address
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Address Line | PO BOX 576900
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City | MODESTO
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State | CA
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Zip | 95357-6900
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Country | US
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Telephone | 209-451-2377
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Fax | 209-433-0441
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRADLEY SMITH
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Credential | MD
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Telephone | 209-571-5071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G79816
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License Number State | CA
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