MEDICARE: DR. RONALD LEE SMITH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1608	CO

General Provider Information

NPI Number	:	1194162685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD LEE SMITH PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 38039
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80937-8039
Country	:	US
Telephone Number	:	719-591-5074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1843 AUSTIN BLUFFS PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7857
Country	:	US
Telephone Number	:	719-591-5074
Fax Number	:	719-314-0135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	11/18/2021

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