Healthcare Provider Details

I. General information

NPI: 1639173024
Provider Name (Legal Business Name): DANIEL RAY SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W BROAD ST STE 300
RICHMOND VA
23230-1709
US

IV. Provider business mailing address

1400 JACKSON ST
DENVER CO
80206-2761
US

V. Phone/Fax

Practice location:
  • Phone: 43-204-2438
  • Fax: 804-622-0552
Mailing address:
  • Phone: 303-388-4461
  • Fax: 303-270-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number42185
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number42185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: