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General NPI Number Information
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NPI Number | 1467291518
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Entity Type | Organization
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Legal Business Name | BRADLEY W. SMITH, D.O., PLLC
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1710 JET STREAM DR STE 215
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-3937
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Country | US
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Telephone | 719-546-6300
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Fax | 719-546-6111
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Provider Business Mailing Address
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Address Line | 44 BRIARGATE TER
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City | PUEBLO
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State | CO
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Zip | 81001-1743
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Country | US
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Telephone | 719-252-3578
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Fax | 719-546-6111
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BRADLEY W SMITH
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Credential | DO
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Telephone | 719-252-3578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS1201X
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Taxonomy Name | Sleep Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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