Provider Demographics
NPI:1497730774
Name:SMITH, SEAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS-EACH
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4613
Mailing Address - Country:US
Mailing Address - Phone:719-526-7653
Mailing Address - Fax:719-526-7673
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS-EACH
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:719-526-7653
Practice Address - Fax:719-526-7673
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN36948208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics