Healthcare Provider Details

I. General information

NPI: 1346283561
Provider Name (Legal Business Name): BENJAMIN G SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE FLETCHER ALLEN HEALTH CARE
BURLINGTON VT
05401
US

IV. Provider business mailing address

3371 W 34TH AVE
DENVER CO
80211-3128
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2727
  • Fax: 802-847-4817
Mailing address:
  • Phone: 303-477-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number042-0011160
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: