Provider Demographics
NPI:1760406656
Name:SMOLLEY, JOHN R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:SMOLLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5738 OLDE WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2535
Mailing Address - Country:US
Mailing Address - Phone:720-898-9292
Mailing Address - Fax:303-456-9284
Practice Address - Street 1:5738 OLDE WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2535
Practice Address - Country:US
Practice Address - Phone:720-898-9292
Practice Address - Fax:303-456-9284
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO367422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC50221Medicare ID - Type Unspecified
COH13033Medicare UPIN