Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 87-350 | NM |
Y | 208800000X | Urologist | 87-350 | NM |
N | 2088P0231X | Pediatric Urologist | 87-350 | NM |
NPI | 1528075579 |
---|---|
Provider Name | Anthony Smith |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 02/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C21990 | (02) |