Individual
DR. BRIAN DAVID SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
825 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9411
(901) 685-2200
(901) 255-5631
Mailing address
PO BOX 22510, JACKSON, MS 39225-2510
(901) 685-2200
(901) 255-5631
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036079800
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036079800
—
IL
Enumeration date
12/16/2005
Last updated
12/13/2022
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