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NPI Code Detail

MEDICARE: DR. JEROME I SMITH M.D.

MEDICARE: DR. JEROME I SMITH M.D.
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
1207Q00000XFamily Medicine Physician17246CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164471397
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEROME I SMITH M.D.
Provider Business Mailing Address
First Line : 3702 AUTOMATION WAY
Second Line : SUITE 103
City : FORT COLLINS
State : CO
Zip : 80525-5737
Country : US
Telephone Number : 970-224-1670
Fax Number : 970-221-5206
Provider Business Practice Location Address
First Line : 2025 BIGHORN RD
Second Line :
City : FT COLLINS
State : CO
Zip : 80525-3480
Country : US
Telephone Number : 970-229-9800
Fax Number : 970-221-5406
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2006
Last Update Date : 01/15/2010

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