Healthcare Provider Details

I. General information

NPI: 1821798935
Provider Name (Legal Business Name): COLE DOUGLAS SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR BLDG 7500 , FIRST FLOOR , ROOM 1310
FORT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7160
  • Fax: 719-526-4903
Mailing address:
  • Phone: 719-526-7160
  • Fax: 719-526-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102208819
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: