MEDICARE: DR. JAMES BRADBURY SMITH MD

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	208600000X	Surgery Physician	38321	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K9658	OTHER	CO	MEDICARE UNSPECIFIED

Other Identifiers

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

General Provider Information

NPI Number	:	1295727840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES BRADBURY SMITH MD

Provider Business Mailing Address
First Line	:	401 KENDALL DRIVE
Second Line	:
City	:	LAMAR
State	:	CO
Zip	:	81052-3943
Country	:	US
Telephone Number	:	719-336-7005
Fax Number	:	719-336-7026

Provider Business Practice Location Address
First Line	:	301 KENDALL DR
Second Line	:
City	:	LAMAR
State	:	CO
Zip	:	81052-3943
Country	:	US
Telephone Number	:	719-336-7005
Fax Number	:	719-336-7026

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	04/08/2015

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