Provider Demographics
NPI:1811326507
Name:SMITH, BRANDON (LP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SPRING HILL DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-6023
Mailing Address - Country:US
Mailing Address - Phone:832-813-5278
Mailing Address - Fax:832-813-8702
Practice Address - Street 1:500 SPRING HILL DR
Practice Address - Street 2:STE. 200
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-6023
Practice Address - Country:US
Practice Address - Phone:832-813-5278
Practice Address - Fax:832-813-8702
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15431744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management