MEDICARE: CHRISTOPHER BRYANT 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	207W00000X	Ophthalmology Physician	2014016539	MO
2	207W00000X	Ophthalmology Physician	10244495-1205	UT

General Provider Information

NPI Number	:	1356780076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER BRYANT SMITH M.D.

Provider Business Mailing Address
First Line	:	2700 HOMESTEAD RD STE 30
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4874
Country	:	US
Telephone Number	:	435-615-0435
Fax Number	:	435-604-0261

Provider Business Practice Location Address
First Line	:	2700 HOMESTEAD RD
Second Line	:	STE 30
City	:	PARK CITY
State	:	UT
Zip	:	84098-4874
Country	:	US
Telephone Number	:	435-658-3090
Fax Number	:	435-604-0261

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

Provider Enumeration Date	:	06/15/2013
Last Update Date	:	07/28/2022

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