Healthcare Provider Details

I. General information

NPI: 1427340009
Provider Name (Legal Business Name): ROBERT M SMITH DPM P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 MOUNTAIN VIEW AVE SUITE 300
LONGMONT CO
80501-3178
US

IV. Provider business mailing address

14391 W 2ND PL
GOLDEN CO
80401-5210
US

V. Phone/Fax

Practice location:
  • Phone: 303-974-7474
  • Fax: 303-997-1085
Mailing address:
  • Phone: 303-974-7474
  • Fax: 303-997-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number657
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT M SMITH
Title or Position: PRESIDENT
Credential: DPM
Phone: 303-974-7474