Provider Demographics
NPI:1679664130
Name:SMITH, ERIC HERBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:HERBERT
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 1:118 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DACONO
Mailing Address - State:CO
Mailing Address - Zip Code:80514-9301
Mailing Address - Country:US
Mailing Address - Phone:303-833-4885
Mailing Address - Fax:
Practice Address - Street 1:118 8TH ST
Practice Address - Street 2:
Practice Address - City:DACONO
Practice Address - State:CO
Practice Address - Zip Code:80514-9301
Practice Address - Country:US
Practice Address - Phone:303-833-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225531208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD24124Medicare UPIN
COC804787Medicare PIN