Healthcare Provider Details

I. General information

NPI: 1366425142
Provider Name (Legal Business Name): PETER CHARLES SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE NORTH MEDICAL OFFICE BUILDING
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-8702
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7050
  • Fax: 970-203-7055
Mailing address:
  • Phone: 970-203-7050
  • Fax: 970-203-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37927
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: