Provider Demographics
NPI:1245280148
Name:MAGUIRE, SARA CHRISTINE SMITH (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:CHRISTINE SMITH
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1333 W 5TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:307-673-3181
Mailing Address - Fax:307-673-3180
Practice Address - Street 1:1333 W 5TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2752
Practice Address - Country:US
Practice Address - Phone:307-673-3181
Practice Address - Fax:307-673-3180
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44285208600000X
WY7693A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44285OtherSTATE MEDICAL LICENSE
WY7693AOtherSTATE MEDICAL LICENSE
WY7693AOtherSTATE MEDICAL LICENSE