Provider Demographics
NPI:1386630234
Name:SMARDO, JACK R (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:R
Last Name:SMARDO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2635 N. 7TH STREET, SUITE 4205
Mailing Address - Street 2:ST. MARY'S HOSPITALIST PROGRAM
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8209
Mailing Address - Country:US
Mailing Address - Phone:970-298-7783
Mailing Address - Fax:970-298-2079
Practice Address - Street 1:499 EAST HAMPDEN
Practice Address - Street 2:#320
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2793
Practice Address - Country:US
Practice Address - Phone:303-781-8439
Practice Address - Fax:303-788-6115
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO24084208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01240845Medicaid
801931Medicare ID - Type Unspecified
D24387Medicare UPIN