MEDICARE: MR. BANFIELD RUEBEN SMITH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4281	CO

General Provider Information

NPI Number	:	1043584667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BANFIELD RUEBEN SMITH FNP

Provider Business Mailing Address
First Line	:	14613 E ATLANTIC DR
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1513
Country	:	US
Telephone Number	:	720-324-8028
Fax Number	:	720-532-0372

Provider Business Practice Location Address
First Line	:	14613 E ATLANTIC DR
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1513
Country	:	US
Telephone Number	:	303-755-1566
Fax Number	:	303-484-6300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	09/05/2018

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