MEDICARE: DR. PAUL MICHAEL 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
1	174400000X	Specialist	32379	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1710957923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MICHAEL SMITH M.D.

Provider Business Mailing Address
First Line	:	310 COLORADO AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004
Country	:	US
Telephone Number	:	719-543-8718
Fax Number	:	719-543-5340

Provider Business Practice Location Address
First Line	:	110 E ROUTT
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81001
Country	:	US
Telephone Number	:	719-543-8711
Fax Number	:	719-543-5340

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	08/19/2008

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