Healthcare Provider Details

I. General information

NPI: 1336567825
Provider Name (Legal Business Name): TIMOTHY JOSEPH SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STEELE ST
DENVER CO
80206-4479
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE
LOVELAND CO
80538-8702
US

V. Phone/Fax

Practice location:
  • Phone: 303-372-4010
  • Fax:
Mailing address:
  • Phone: 970-624-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2016-0912
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-44950
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0072563
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: