Provider Demographics
NPI:1437270006
Name:SMITH, GREGORY DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DEAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19515 E 54TH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8677
Mailing Address - Country:US
Mailing Address - Phone:303-912-3040
Mailing Address - Fax:720-645-1940
Practice Address - Street 1:19515 E 54TH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8677
Practice Address - Country:US
Practice Address - Phone:303-912-3040
Practice Address - Fax:303-912-3040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26559207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine