Provider Demographics
NPI:1306919352
Name:SMITH, JOSEPH MYLES (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MYLES
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1606 PRAIRIE CENTER PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-655-1685
Mailing Address - Fax:303-655-1703
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-655-1685
Practice Address - Fax:303-655-1703
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO36671208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63382547Medicaid