Provider Demographics
NPI:1245462936
Name:SMITH, BRENDAN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:PATRICK
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 1:11808 NORTHUP WAY STE W300
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1938
Mailing Address - Country:US
Mailing Address - Phone:425-284-1547
Mailing Address - Fax:425-284-1546
Practice Address - Street 1:11808 NORTHUP WAY STE W300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-284-1547
Practice Address - Fax:425-284-1546
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60727545207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program