Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 657 | CO |
NPI | 1083639173 |
---|---|
Provider Name | Dr. Robert Matthew Smith |
First Address | Golden, CO 80401-5210 |
Second Address | Longmont, CO 80501-3178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 13/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7641870 | AETNA (01) | |
841175163004 | ROCKY MOUNTAIN HP (01) | |
84-1175163-04 | PACIFICARE (01) | |
V10610 | (02) | |
V10610 | (02) | CO |