Provider Demographics
NPI:1972009116
Name:SMOUSE, COLTEN (DO)
Entity Type:Individual
Prefix:
First Name:COLTEN
Middle Name:
Last Name:SMOUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81073-1699
Mailing Address - Country:US
Mailing Address - Phone:719-523-6628
Mailing Address - Fax:719-523-4290
Practice Address - Street 1:900 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:CO
Practice Address - Zip Code:81073-1636
Practice Address - Country:US
Practice Address - Phone:719-523-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0066584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine