Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 128925 | CO |
NPI | 1003033424 |
---|---|
Provider Name | Brandi D Smalley |
First Address | Broomfield, CO 80020-3850 |
Second Address | Lafayette, CO 80026-3370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016847 | KAISER-COMMERCIAL NUMBER (01) |