Healthcare Provider Details

I. General information

NPI: 1730829516
Provider Name (Legal Business Name): AMANDA JEAN SMITH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 INTERNATIONAL CIR
COLORADO SPRINGS CO
80910-3139
US

IV. Provider business mailing address

2350 INTERNATIONAL CIR
COLORADO SPRINGS CO
80910-3139
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-5065
  • Fax: 719-475-5797
Mailing address:
  • Phone: 719-475-5065
  • Fax: 719-475-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0077235
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: