Healthcare Provider Details

I. General information

NPI: 1497730774
Provider Name (Legal Business Name): SEAN T. SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR DEPARTMENT OF PEDIATRICS-EACH
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR DEPARTMENT OF PEDIATRICS-EACH
FORT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7653
  • Fax: 719-526-7673
Mailing address:
  • Phone: 719-526-7653
  • Fax: 719-526-7673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36948
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0060438
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: