Provider Demographics
NPI:1003004672
Name:BRYSON S. SMITH, MD, PC
Entity Type:Organization
Organization Name:BRYSON S. SMITH, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYSON
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-387-6520
Mailing Address - Street 1:4403 HARRISON BLVD
Mailing Address - Street 2:SUITE 1815
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3271
Mailing Address - Country:US
Mailing Address - Phone:801-387-6520
Mailing Address - Fax:801-387-6525
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:SUITE 1815
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-6520
Practice Address - Fax:801-387-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTB56692Medicare UPIN
UT000061492Medicare PIN