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Individual
BRYAN WESLEY SMITH
Active
Individual
BRYAN WESLEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2080S0010X
Pediatric Sports Medicine Physician
Primary
34586
SC
2080S0010X
Pediatric Sports Medicine Physician
39745
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7977421
—
NC
Enumeration date
05/21/2012
Last updated
05/21/2012
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