Individual
MATTHEW BRADLEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
122 COLUMBUS RD, FREDERICKTOWN, OH 43019-1266
(740) 694-1261
(740) 694-7145
Mailing address
122 COLUMBUS RD, FREDERICKTOWN, OH 43019-1266
(740) 694-1261
(740) 694-7145
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.080703
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000228476
ANTHEM BC/BS
OH
01
—
2236399
UNITED HEALTHCARE OF OHIO
OH
05
—
2327520
—
OH
Enumeration date
06/16/2006
Last updated
04/02/2008
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