Provider Demographics
NPI:1033483250
Name:SMILEY, JOHN WALLACE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALLACE
Last Name:SMILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5746 GREENSPOINTE WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-3359
Mailing Address - Country:US
Mailing Address - Phone:303-470-6364
Mailing Address - Fax:
Practice Address - Street 1:5746 GREENSPOINTE WAY
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-3359
Practice Address - Country:US
Practice Address - Phone:303-470-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15511208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery