MEDICARE: BRIONNE SMITH

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	208100000X	Physical Medicine & Rehabilitation Physician	2147936	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000000000	OTHER		N/A

General Provider Information

NPI Number	:	1265085872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIONNE SMITH

Provider Business Mailing Address
First Line	:	2203 LAUREL BRANCH WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-2451
Country	:	US
Telephone Number	:	713-992-2183
Fax Number	:

Provider Business Practice Location Address
First Line	:	11120 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1029
Country	:	US
Telephone Number	:	281-875-1800
Fax Number	:

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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Directions to “ BRIONNE SMITH ” Practice Location

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