Provider Demographics
NPI:1356478887
Name:SMITH, BRAD E R (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:E R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1213 N SHERMAN AVE
Mailing Address - Street 2:#154
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4236
Mailing Address - Country:US
Mailing Address - Phone:608-204-6122
Mailing Address - Fax:608-204-6123
Practice Address - Street 1:301 TROY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-1521
Practice Address - Country:US
Practice Address - Phone:608-301-1576
Practice Address - Fax:608-301-1571
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI39157-0202084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry