Healthcare Provider Details

I. General information

NPI: 1437103157
Provider Name (Legal Business Name): JOSEPH M. SMITH III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490B W ZIA RD SUITE A
SANTA FE NM
87505-6996
US

IV. Provider business mailing address

19420 N 59TH AVE SUITE B233
GLENDALE AZ
85308-6894
US

V. Phone/Fax

Practice location:
  • Phone: 505-995-8346
  • Fax: 505-995-8345
Mailing address:
  • Phone: 623-234-2542
  • Fax: 623-234-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number93154
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: