Provider Demographics
NPI:1760480123
Name:SMITH, DAMON EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:EARL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10463 PARK MEADOWS DR STE 114
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5317
Mailing Address - Country:US
Mailing Address - Phone:303-733-8848
Mailing Address - Fax:
Practice Address - Street 1:10463 PARK MEADOWS DR STE 114
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5317
Practice Address - Country:US
Practice Address - Phone:303-733-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72842174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G728420Medicaid
CODR.0066431OtherSTATE LICENSE
CAG72842OtherSTATE LICENSE
CAWG72842HMedicare PIN
CR619YMedicare PIN
CAWA72842JMedicare PIN
CAWG72842KMedicare PIN
CAWG72842Medicare ID - Type Unspecified
CAWG72842GMedicare PIN
CAWG72842FMedicare PIN
CABS3033836OtherDEA CERTIFICATE