Healthcare Provider Details

I. General information

NPI: 1801422803
Provider Name (Legal Business Name): MALLORY ELIZABETH SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORY ELIZABETH MYERS

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S GARFIELD ST
DENVER CO
80209-3186
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-5456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD223422
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT9800
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0077358
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: