Provider Demographics
NPI:1982687059
Name:SMITH, ROBERT BRUNTON (MD,)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUNTON
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 1:108 TIMBER RUN
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6842
Mailing Address - Country:US
Mailing Address - Phone:636-244-2032
Mailing Address - Fax:800-331-5840
Practice Address - Street 1:1015 BOWLES AVE
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2394
Practice Address - Country:US
Practice Address - Phone:636-496-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28304207P00000X
MO2000148568207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO147480058Medicare PIN
G34387Medicare UPIN
MO951743849Medicare ID - Type Unspecified
MO208890244Medicare ID - Type Unspecified