Healthcare Provider Details

I. General information

NPI: 1245225093
Provider Name (Legal Business Name): DANIEL R SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 EUCLID AVE
CARBONDALE CO
81623-1839
US

IV. Provider business mailing address

978 EUCLID AVE
CARBONDALE CO
81623-1839
US

V. Phone/Fax

Practice location:
  • Phone: 970-963-3350
  • Fax:
Mailing address:
  • Phone: 970-963-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44181
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31675
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: