Brad D Smith, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

O 0374 Issued in ID

Practice address

2805 Valencia Dr
Idaho Falls, ID 83404-7597

Phone

(208) 552-3184

Fax

(208) 525-6151

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515024000000",
    "number": "1144243767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 VALENCIA DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047597",
            "telephone_number": "208-542-2787",
            "fax_number": "208-525-6151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 VALENCIA DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047597",
            "telephone_number": "208-552-3184",
            "fax_number": "208-525-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BRAD",
        "middle_name": "D",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2018-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "O 0374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807431800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sleep Disorder Center of Eastern Idaho, Inc.
• Jerry B Smedley, D.O.
• Allison Rae Smith-Varela, RBT
• Amanda Rae Smith
• Benjamin Smith, DO
• Brandi Jo Smith, APRN-CNP
• Brittany Smith
• Brodi Smith, DO
• Caren J Smith, PA-C
• Carson Smith

• Surgery Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.