Provider Demographics
NPI:1467595025
Name:SMITH, RUSSELL LYNN (CMT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 E QUINCY AVE D212
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2456
Mailing Address - Country:US
Mailing Address - Phone:303-741-2736
Mailing Address - Fax:
Practice Address - Street 1:8330 E QUINCY AVE APT D212
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2456
Practice Address - Country:US
Practice Address - Phone:303-741-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist