Provider Demographics
NPI:1326010240
Name:SMITH, HERMAN BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:BRADLEY
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:PO BOX 15064
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-5064
Mailing Address - Country:US
Mailing Address - Phone:602-999-8744
Mailing Address - Fax:602-840-1782
Practice Address - Street 1:4971 E LAFAYETTE BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4429
Practice Address - Country:US
Practice Address - Phone:602-999-8744
Practice Address - Fax:602-840-1782
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21590207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
70035Medicare ID - Type Unspecified
E80696Medicare UPIN