MEDICARE: MR. RUSSELL LYNN SMITH CMT

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	174400000X	Specialist

General Provider Information

NPI Number	:	1467595025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSSELL LYNN SMITH CMT

Provider Business Mailing Address
First Line	:	8330 E QUINCY AVE D212
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-2456
Country	:	US
Telephone Number	:	303-741-2736
Fax Number	:

Provider Business Practice Location Address
First Line	:	8330 E QUINCY AVE APT D212
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-2456
Country	:	US
Telephone Number	:	303-741-2736
Fax Number	:

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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