Provider Demographics
NPI:1942493622
Name:SMITH, JAMES BRANDON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRANDON
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 1:3501 MACCORKLE AVE SE # 303
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1419
Mailing Address - Country:US
Mailing Address - Phone:304-807-0337
Mailing Address - Fax:
Practice Address - Street 1:321 DRY HILL RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2601
Practice Address - Country:US
Practice Address - Phone:304-250-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26004208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5822F058OtherPTAN