Provider Demographics
NPI:1639456346
Name:SMITHSON, BRYCE COREY (MD)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:COREY
Last Name:SMITHSON
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 1:222 ALEXANDER ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-4039
Mailing Address - Country:US
Mailing Address - Phone:585-922-0555
Mailing Address - Fax:
Practice Address - Street 1:1600 OWENS ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2261
Practice Address - Country:US
Practice Address - Phone:415-833-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116467208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics