Provider Demographics
NPI:1881762904
Name:SMITH, BRIAN RANDAL (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RANDAL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 N 15TH LN
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3352
Mailing Address - Country:US
Mailing Address - Phone:956-618-1623
Mailing Address - Fax:956-444-3298
Practice Address - Street 1:601 W SESAME DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7930
Practice Address - Country:US
Practice Address - Phone:956-423-0130
Practice Address - Fax:956-444-3298
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH72302083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH7230OtherMEDICAL LICENSE
TXH7230OtherMEDICAL LICENSE