Provider Demographics
NPI:1114938438
Name:SMITH, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9901
Mailing Address - Country:US
Mailing Address - Phone:913-962-2122
Mailing Address - Fax:913-962-2422
Practice Address - Street 1:7230 RENNER RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9901
Practice Address - Country:US
Practice Address - Phone:913-962-2122
Practice Address - Fax:913-962-2422
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430016207RG0100X
MO2001013153207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H81373Medicare UPIN
KSK33C346Medicare PIN
MOK33C346AMedicare PIN