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Individual
BRADLEY SMITH
Active
Individual
BRADLEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA249
ME
363A00000X
Physician Assistant
Primary
PA-249
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245465038
—
ME
Enumeration date
05/21/2009
Last updated
04/01/2019
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