Individual
BRETT A SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3118
(208) 547-0424
Mailing address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3341
(208) 547-2790
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-422
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548930878
—
ID
Enumeration date
11/09/2005
Last updated
10/12/2022
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