Provider Demographics
NPI:1790888691
Name:SMITH, WADE R (MD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-209-2503
Mailing Address - Fax:303-761-0803
Practice Address - Street 1:701 E HAMPDEN AVE
Practice Address - Street 2:#515
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2736
Practice Address - Country:US
Practice Address - Phone:303-209-2503
Practice Address - Fax:303-761-0803
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD048555L207X00000X
CO36792207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025942600Medicaid
WY1790888691Medicaid
CO18455573Medicaid
COCOAAA0480Medicare PIN
CO18455573Medicaid
G16445Medicare UPIN
COD11284Medicare PIN