Provider Demographics
NPI:1295727840
Name:SMITH, JAMES BRADBURY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRADBURY
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 1:401 KENDALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3943
Mailing Address - Country:US
Mailing Address - Phone:719-336-7005
Mailing Address - Fax:719-336-7026
Practice Address - Street 1:301 KENDALL DR
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3943
Practice Address - Country:US
Practice Address - Phone:719-336-7005
Practice Address - Fax:719-336-7026
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38321208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COK9658OtherMEDICARE UNSPECIFIED
CO93787588Medicaid
G74669Medicare UPIN
COK9658OtherMEDICARE UNSPECIFIED
CO93787588Medicaid