Provider Demographics
NPI:1093998890
Name:VERNON M. SMITH JR, MD PC
Entity Type:Organization
Organization Name:VERNON M. SMITH JR, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-232-7660
Mailing Address - Street 1:1805 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1477
Mailing Address - Country:US
Mailing Address - Phone:303-232-7660
Mailing Address - Fax:303-934-7332
Practice Address - Street 1:1805 KIPLING ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1477
Practice Address - Country:US
Practice Address - Phone:303-232-7660
Practice Address - Fax:303-934-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCJ7189OtherRRW MEDICARE
CO01248608Medicaid
CO01248608Medicaid
E05462Medicare UPIN