MEDICARE: BRYAN DAVID SMITH MD

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	208800000X	Urology Physician	A73728	CA
2	208800000X	Urology Physician	MD28964	OR
3	208800000X	Urology Physician	MD00049274	WA
4	208800000X	Urology Physician	M12316	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8948199	OTHER	WA	L & I CRIME VICTIMS
3	0238521	OTHER	WA	L & I

General Provider Information

NPI Number	:	1548243199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN DAVID SMITH MD

Provider Business Mailing Address
First Line	:	825 SE BISHOP BLVD STE 101
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-5517
Country	:	US
Telephone Number	:	509-332-3488
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 SE BISHOP BLVD STE 101
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-5517
Country	:	US
Telephone Number	:	509-332-3488
Fax Number	:

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	04/29/2014

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Directions to “ BRYAN DAVID SMITH MD” Practice Location

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