Healthcare Provider Details

I. General information

NPI: 1164244562
Provider Name (Legal Business Name): JAMIE ANN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 DESERT FOX TRL
MORRISON CO
80465
US

IV. Provider business mailing address

255 UNION BLVD STE 350
LAKEWOOD CO
80228-1877
US

V. Phone/Fax

Practice location:
  • Phone: 303-999-5101
  • Fax:
Mailing address:
  • Phone: 303-238-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberPA.0009564
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: