Organization
BRADLEY W. SMITH, D.O., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY WAYNE SMITH D.O. (PRESIDENT)
(719) 546-6300
Entity
Organization
Contact information
Practice address
44 BRIARGATE TER, PUEBLO, CO 81001-1743
(719) 546-6300
(719) 546-6111
Mailing address
44 BRIARGATE TER, PUEBLO, CO 81001-1743
(719) 546-6300
(719) 546-6111
Taxonomy
Speciality
Code
Description
License number
State
207QS1201X
Sleep Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21159335
—
CO
01
—
P00392252
RAILROAD MEDICARE
CO
Enumeration date
03/30/2007
Last updated
05/20/2024
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