Individual
JOHN W SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
704 EDWARDS ST, WESTCLIFFE, CO 81252-8588
(719) 783-2380
(719) 783-2377
Mailing address
704 EDWARDS AVE, WESTCLIFFE, CO 81252-8588
(719) 783-2380
(719) 783-2377
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO.0052600
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
464789YNXL
MEDICARE A & B
CO
Enumeration date
08/16/2006
Last updated
10/03/2016
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