Basic Information
| Provider Information | |||||||||
| NPI: | 1245462936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | BRENDAN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11808 NORTHUP WAY STE W300 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980051938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252841547 | ||||||||
| FaxNumber: | 4252841546 | ||||||||
| Practice Location | |||||||||
| Address1: | 11808 NORTHUP WAY STE W300 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252841547 | ||||||||
| FaxNumber: | 4252841546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2009 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | MD60727545 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.