Provider Demographics
NPI:1134260086
Name:MANG-SMITH, KATIE JANE (MD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JANE
Last Name:MANG-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WELLINGTON AVE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6132
Mailing Address - Country:US
Mailing Address - Phone:970-243-7908
Mailing Address - Fax:970-245-0656
Practice Address - Street 1:750 WELLINGTON AVE
Practice Address - Street 2:SUITE 3C
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6132
Practice Address - Country:US
Practice Address - Phone:970-243-7908
Practice Address - Fax:970-245-0656
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86526537Medicaid