Provider Demographics
NPI:1174616130
Name:SMITH, HUNTER RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:HUNTER
Middle Name:RUSSELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-5399
Mailing Address - Fax:303-297-5808
Practice Address - Street 1:4820 RIVERBEND RD STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2618
Practice Address - Country:US
Practice Address - Phone:303-415-5399
Practice Address - Fax:303-297-5808
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24423207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01244235Medicaid
COD24446Medicare UPIN
COC525978Medicare PIN