Provider Demographics
NPI:1891902573
Name:SMITH, BRICE T (MD)
Entity Type:Individual
Prefix:DR
First Name:BRICE
Middle Name:T
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 1:8345 NW 66TH ST
Mailing Address - Street 2:#3824
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2626
Mailing Address - Country:US
Mailing Address - Phone:305-807-3799
Mailing Address - Fax:
Practice Address - Street 1:8345 NW 66TH ST
Practice Address - Street 2:#3824
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-2626
Practice Address - Country:US
Practice Address - Phone:305-807-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ204372085R0202X
GA0537252085R0202X
NC2000015362085R0202X
OK251542085R0202X
TN363302085R0202X
TXL47222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F45423Medicare UPIN