Individual
MR. BRYAN JUDSON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DIVE IDC
Contact information
Practice address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(619) 532-6064
Mailing address
62468 HIGHWAY 49, LINEVILLE, AL 36266-4923
(240) 478-1870
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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