MEDICARE: BRIANT W 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	207X00000X	Orthopaedic Surgery Physician	G61163	CA

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

General Provider Information

NPI Number	:	1639253628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANT W SMITH MD

Provider Business Mailing Address
First Line	:	325 DISTEL CIR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1408
Country	:	US
Telephone Number	:	707-521-7799
Fax Number	:	707-521-8951

Provider Business Practice Location Address
First Line	:	3883 AIRWAY DR
Second Line	:	SUITE 165
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1670
Country	:	US
Telephone Number	:	707-521-7799
Fax Number	:	707-521-8951

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/17/2020

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