Provider Demographics
NPI:1316035371
Name:SMITH, EDWIN R (MD)
Entity Type:Individual
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First Name:EDWIN
Middle Name:R
Last Name:SMITH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3333 S BANNOCK ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2432
Mailing Address - Country:US
Mailing Address - Phone:303-957-1310
Mailing Address - Fax:303-761-4252
Practice Address - Street 1:7750 S BROADWAY
Practice Address - Street 2:SUITE 230
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2623
Practice Address - Country:US
Practice Address - Phone:303-798-8811
Practice Address - Fax:303-798-1233
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-03-24
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Provider Licenses
StateLicense IDTaxonomies
CO23523208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01235233Medicaid
CO01235233Medicaid
CO349548Medicare PIN