Provider Demographics
NPI:1679957211
Name:SMITH, SCOTT R (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2801 PURCELL ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3551
Mailing Address - Country:US
Mailing Address - Phone:303-659-7600
Mailing Address - Fax:303-558-8223
Practice Address - Street 1:1601 E 19TH AVE STE 3300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1239
Practice Address - Country:US
Practice Address - Phone:303-837-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant