Basic Information
| Provider Information | |||||||||
| NPI: | 1669507984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | BRYSON | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4403 HARRISON BLVD. | ||||||||
| Address2: | SUITE 1815 | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844033339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017325900 | ||||||||
| FaxNumber: | 8017325988 | ||||||||
| Practice Location | |||||||||
| Address1: | 4403 HARRISON BLVD. | ||||||||
| Address2: | SUITE 1815 | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844033339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017325930 | ||||||||
| FaxNumber: | 8017325988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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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 | 174400000X | 262635-1205 | UT | N | Other Service Providers | Specialist | 207T00000X | 262635-1205 | UT | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.