Healthcare Provider Details

I. General information

NPI: 1821153644
Provider Name (Legal Business Name): PHILIP SMALDONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NH 120 COORS BREWING COMPANY
GOLDEN CO
80401-0030
US

IV. Provider business mailing address

40 BURTON HILLS BLVD SUITE 200
NASHVILLE TN
37215-6155
US

V. Phone/Fax

Practice location:
  • Phone: 303-277-2138
  • Fax: 303-277-6915
Mailing address:
  • Phone: 615-565-1733
  • Fax: 615-296-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCO33126
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: