Provider Demographics
NPI:1932195542
Name:BAYNARD-SMITH, BRENNA ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:ELAINE
Last Name:BAYNARD-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRENNA
Other - Middle Name:BAYNARD
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 S 7TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3057
Mailing Address - Country:US
Mailing Address - Phone:760-255-2400
Mailing Address - Fax:760-255-4646
Practice Address - Street 1:500 S 7TH AVE STE A
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3057
Practice Address - Country:US
Practice Address - Phone:760-255-2400
Practice Address - Fax:760-255-4646
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-10-01
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-18
Provider Licenses
StateLicense IDTaxonomies
CAG65654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164567426OtherNPI GROUP II
CA330927078OtherTAX ID
CAZZZ07612ZMedicare PIN
CAE80534Medicare UPIN