Individual
DR. BRADLEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1106 S PACIFIC COAST HWY, REDONDO BEACH, CA 90277-4902
(310) 316-1661
Mailing address
1106 S PACIFIC COAST HWY, REDONDO BEACH, CA 90277-4902
(310) 316-1661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G066535
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ32051Z
BLUE SHIELD
CA
05
—
ZZZ32051Z
—
CA
Enumeration date
11/08/2006
Last updated
03/21/2008
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