Provider Demographics
NPI:1669507984
Name:SMITH, BRYSON S (MD)
Entity Type:Individual
Prefix:
First Name:BRYSON
Middle Name:S
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 1:4403 HARRISON BLVD.
Mailing Address - Street 2:SUITE 1815
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3339
Mailing Address - Country:US
Mailing Address - Phone:801-732-5900
Mailing Address - Fax:801-732-5988
Practice Address - Street 1:4403 HARRISON BLVD.
Practice Address - Street 2:SUITE 1815
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3339
Practice Address - Country:US
Practice Address - Phone:801-732-5930
Practice Address - Fax:801-732-5988
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT262635-1205174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTB56692Medicare UPIN
UT000010837Medicare ID - Type Unspecified