Provider Demographics
NPI:1083940894
Name:SMITH, BRUCE A JR (CST/FA)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:A
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:CST/FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:LA FRANCE
Mailing Address - State:SC
Mailing Address - Zip Code:29656-0301
Mailing Address - Country:US
Mailing Address - Phone:864-346-9351
Mailing Address - Fax:864-877-5295
Practice Address - Street 1:241 DEAN RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-7451
Practice Address - Country:US
Practice Address - Phone:864-346-9351
Practice Address - Fax:864-877-5295
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZS0410X
SC246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist