Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 041965 | CT |
NPI | 1073506531 |
---|---|
Provider Name | Dr. Kenneth J Smith |
First Address | Albuquerque, NM 87110-7613 |
Second Address | Albuquerque, NM 87110-7613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 12/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001419656 | (05) | CT |
010041965CT03 | ANTHEM BCBS (01) | CT |
041965 | CONNECTICARE (01) | CT |
2V5874 | HEALTHNET (01) | |
D43314 | (02) | |
P3157657 | OXFORD (01) |