Individual
BRENNEN D SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2400 ST FRANCIS DR, BRECKENRIDGE, MN 56520-1025
(218) 643-3000
(218) 643-0850
Mailing address
4784 AMBER VALLEY PKWY S, CHI PROVIDER ENROLLMENT - FARGO DIVISON, FARGO, ND 58104-8614
(701) 237-8072
(937) 599-1730
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
15379
ND
207XS0117X
Orthopaedic Surgery of the Spine Physician
34.010178
OH
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
61204
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000480404
OH MEDICAID UNISON
OH
05
—
1471472
—
ND
05
—
3158630
—
OH
05
—
3810022462
—
WV
Enumeration date
05/22/2007
Last updated
10/02/2019
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