Provider Demographics
NPI:1336105105
Name:SMETANA, SCOTT M (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:SMETANA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2770 N UNION BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1120
Mailing Address - Country:US
Mailing Address - Phone:719-471-2020
Mailing Address - Fax:719-633-7379
Practice Address - Street 1:2770 N UNION BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1120
Practice Address - Country:US
Practice Address - Phone:719-471-2020
Practice Address - Fax:719-633-7379
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-05-12
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Provider Licenses
StateLicense IDTaxonomies
CO42437207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00167767OtherRAILROAD MEDICARE
CO0362080001OtherPALMETTO GBA
CO33973873Medicaid
CO0362080001OtherPALMETTO GBA
CO33973873Medicaid