Provider Demographics
NPI:1588608970
Name:SMITH, BRADLEY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:THOMAS
Last Name:SMITH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2201 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1870
Mailing Address - Country:US
Mailing Address - Phone:314-367-1181
Mailing Address - Fax:314-968-5117
Practice Address - Street 1:17 THE BOULEVARD SAINT LOUIS
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1118
Practice Address - Country:US
Practice Address - Phone:314-367-1181
Practice Address - Fax:314-968-5117
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-02-04
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Provider Licenses
StateLicense IDTaxonomies
MO2006005754207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I68393Medicare UPIN