Provider Demographics
NPI:1912987306
Name:SMITH, BRETT R (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30532
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1532
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:850-916-3710
Practice Address - Street 1:1040 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7809
Practice Address - Country:US
Practice Address - Phone:850-916-3700
Practice Address - Fax:850-916-3710
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30241207X00000X
PAMD073529L207X00000X
FLME105667207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2698586Medicaid
7998568OtherAETNA
FL146QJOtherBLUE CROSS BLUE SHIELD
P00807016OtherMEDICARE RAILROAD
AL592-09123OtherBLUE CROSS BLUE SHIELD
PA1017642910001Medicaid
AL592-09139OtherBLUE CROSS BLUE SHIELD
FL001853100Medicaid
AL114534Medicaid
AL115066Medicaid
WV3810008259Medicaid
AZ881244Medicaid
PA106732NH3Medicare PIN
AL114534Medicaid
AZ881244Medicaid
FLCS347ZMedicare PIN