MEDICARE: BRUCE W SMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	70411	MA

General Provider Information

NPI Number	:	1124065826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE W SMITH M.D.

Provider Business Mailing Address
First Line	:	42 ASBURY ST
Second Line	:
City	:	S HAMILTON
State	:	MA
Zip	:	01982-1808
Country	:	US
Telephone Number	:	978-468-4101
Fax Number	:	978-468-7067

Provider Business Practice Location Address
First Line	:	42 ASBURY ST
Second Line	:	PATTON PARK MED.CENTER
City	:	S HAMILTON
State	:	MA
Zip	:	01982-1808
Country	:	US
Telephone Number	:	978-468-4101
Fax Number	:	978-468-7067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/22/2015

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