Healthcare Provider Details

I. General information

NPI: 1760387930
Provider Name (Legal Business Name): ELIZABETH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 ARAPAHOE AVE
BOULDER CO
80303-1385
US

IV. Provider business mailing address

585 VIRIDIAN DR APT 345
LAFAYETTE CO
80026-7059
US

V. Phone/Fax

Practice location:
  • Phone: 303-385-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number1002533-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: