=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447392386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEBRAJ SMITH M.D.P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2050 B SOUTH MAIN
-----------------------------------------------------
City | DELTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-874-4473
-----------------------------------------------------
Fax | 979-874-8681
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 N GRAND MESA DR
-----------------------------------------------------
City | CEDAREDGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81413-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-856-4306
-----------------------------------------------------
Fax | 970-856-4359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DEBRA JEAN SMITH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 970-856-4306
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 40532
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------