Healthcare Provider Details

I. General information

NPI: 1821041245
Provider Name (Legal Business Name): MATTHEW RICHARD SMOLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO ST STE 130
DURANGO CO
81301-7306
US

IV. Provider business mailing address

301 JUNCTION HWY STE 220
KERRVILLE TX
78028-4203
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-1120
  • Fax: 970-247-1120
Mailing address:
  • Phone: 830-896-3730
  • Fax: 830-792-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR9691
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberDR.0027306
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberR9691
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: