Healthcare Provider Details

I. General information

NPI: 1063610632
Provider Name (Legal Business Name): CLAIRE M SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 TIJERAS AVE NW
ALBUQUERQUE NM
87102-3096
US

IV. Provider business mailing address

98 JEROME RD
LOS LUNAS NM
87031-5729
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-2223
  • Fax: 505-243-3576
Mailing address:
  • Phone: 505-243-2223
  • Fax: 505-243-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number69-190
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: