Provider Demographics
NPI:1952393829
Name:SMITH, CHRISTOPHER MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13605 XAVIER LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3601
Mailing Address - Country:US
Mailing Address - Phone:303-404-3376
Mailing Address - Fax:303-439-9044
Practice Address - Street 1:13605 XAVIER LN
Practice Address - Street 2:SUITE B
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-3601
Practice Address - Country:US
Practice Address - Phone:303-404-3376
Practice Address - Fax:303-439-9044
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0036147207N00000X
CO36147207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO070010405OtherRAILROAD MEDICARE
COG48104Medicare UPIN
COC806821Medicare PIN