Healthcare Provider Details

I. General information

NPI: 1184893216
Provider Name (Legal Business Name): AIMEE CAROLINE SMIDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE CAROLINE HAWROT M.D.

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF NEW MEXICO DEPT OF DERMATOLOGY 1021 MEDICAL ARTS AVE NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6000
  • Fax: 505-272-6003
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD2009-0548
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: