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General NPI Number Information
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NPI Number | 1083639173
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Entity Type | Individual
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Provider Name | ROBERT MATTHEW SMITH D.P.M, C.PED
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 2030 MOUNTAIN VIEW AVE SUITE 300
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City | LONGMONT
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State | CO
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Zip | 80501-3178
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Country | US
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Telephone | 303-974-7474
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Fax | 303-997-1085
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Provider Business Mailing Address
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Address Line | 14391 W 2ND PL
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City | GOLDEN
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State | CO
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Zip | 80401-5210
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Country | US
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Telephone | 215-888-2970
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Fax | 303-997-1085
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 657
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License Number State | CO
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