Provider Demographics
NPI:1760546808
Name:SMITH, DARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DARVIN
Middle Name:
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 1:3228 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2113
Mailing Address - Country:US
Mailing Address - Phone:303-444-4747
Mailing Address - Fax:303-927-7717
Practice Address - Street 1:3228 9TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2113
Practice Address - Country:US
Practice Address - Phone:303-444-4747
Practice Address - Fax:303-927-7717
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDO298207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22709Medicare UPIN