Provider Demographics
NPI:1366001943
Name:SMITH, ANTHONY R
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4164 AUSTIN BLUFFS PKWY # 603
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2928
Mailing Address - Country:US
Mailing Address - Phone:303-704-4621
Mailing Address - Fax:
Practice Address - Street 1:4164 AUSTIN BLUFFS PKWY # 603
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2928
Practice Address - Country:US
Practice Address - Phone:303-704-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic