Individual
BRADLEY A SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1233 34TH ST NW, BEMIDJI, MN 56601-5112
(218) 333-5000
(218) 759-5279
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9736
MN
363AM0700X
Medical Physician Assistant
9736
MN
363AS0400X
Surgical Physician Assistant
9736
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049812200
—
MN
Enumeration date
07/24/2006
Last updated
03/27/2023
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