Provider Demographics
NPI:1083639173
Name:SMITH, ROBERT MATTHEW (DPM, CPED)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MATTHEW
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14391 W 2ND PL
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5210
Mailing Address - Country:US
Mailing Address - Phone:215-888-2970
Mailing Address - Fax:303-997-1085
Practice Address - Street 1:2030 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3178
Practice Address - Country:US
Practice Address - Phone:303-974-7474
Practice Address - Fax:303-997-1085
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO657213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
841175163004OtherROCKY MOUNTAIN HP
7641870OtherAETNA
84-1175163-04OtherPACIFICARE
84-1175163-04OtherPACIFICARE
V10610Medicare UPIN
COC806444Medicare PIN
7641870OtherAETNA