Provider Demographics
NPI:1801076898
Name:SMITH, BRUCE WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WALTER
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:CSU HEALTH NETWORK
Mailing Address - Street 2:8031 CAMPUS DELIVERY
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-8031
Mailing Address - Country:US
Mailing Address - Phone:970-491-1706
Mailing Address - Fax:
Practice Address - Street 1:CSU HEALTH NETWORK
Practice Address - Street 2:8031 CAMPUS DELIVERY
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-8031
Practice Address - Country:US
Practice Address - Phone:970-491-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0938207Q00000X
CO32527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine