Provider Demographics
NPI:1164471397
Name:SMITH, JEROME I (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:I
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3702 AUTOMATION WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5737
Mailing Address - Country:US
Mailing Address - Phone:970-224-1670
Mailing Address - Fax:970-221-5206
Practice Address - Street 1:2025 BIGHORN RD
Practice Address - Street 2:
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3480
Practice Address - Country:US
Practice Address - Phone:970-229-9800
Practice Address - Fax:970-221-5406
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2010-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO17246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01172469Medicaid
CO01172469Medicaid
COD23227Medicare UPIN