Provider Demographics
NPI:1497869580
Name:SMITH, BRADFORD DOUGLASS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:DOUGLASS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:8TH AVENUE AND C STREET
Practice Address - Street 2:LDS HOSPITAL
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4977139-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107027622101OtherIHC
UT77514OtherPEHP
UT850715OtherDESERET MUTUAL
UT2090168OtherUNITED HEALTHCARE
ID806852300Medicaid
UTQM0000075886OtherALTIUS
UT1502954OtherUMWA
UT870545614BDSOtherEDUCATORS MUTUAL
NV100503114Medicaid
UT49771391200001OtherBCBS
WY119554900Medicaid
UT70622OtherHEALTHY U
AZ855398Medicaid
UTTPRA09322OtherMOLINA
UT49771391200001OtherBCBS
UT055327131Medicare ID - Type Unspecified