Individual
BRUCE D SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4017 RAWLINS ST, CHEYENNE, WY 82001-1800
(307) 635-2562
(307) 432-2676
Mailing address
PO BOX 20970, CHEYENNE, WY 82003-7020
(307) 635-2562
(307) 432-2676
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
1724
SD
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
20195
NE
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
27005
IA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
6931A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1185322 00
—
WY
01
—
312201
BLUE CROSS BLUE SHIELD
WY
01
—
P00048676
RAIL ROAD MEDICARE
WY
Enumeration date
10/16/2006
Last updated
01/31/2014
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