Provider Demographics
NPI:1174724652
Name:SMITH, ERIC BRIAN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:BRIAN
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 1:60507 SEVENTH MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1940
Mailing Address - Country:US
Mailing Address - Phone:541-977-8501
Mailing Address - Fax:
Practice Address - Street 1:60507 SEVENTH MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1940
Practice Address - Country:US
Practice Address - Phone:541-977-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57258207L00000X
ORMD27389207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology