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General NPI Number Information
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NPI Number | 1073506531
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Entity Type | Individual
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Provider Name | KENNETH J SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 8300 CONSTITUTION AVE. NE PRESBYTERIAN ONCOLOGY KASEMAN HOSPITAL
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7613
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Country | US
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Telephone | 505-559-6199
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Fax | 505-559-6101
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Provider Business Mailing Address
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Address Line | 8300 CONSTITUTION AVE. NE PRESBYTERIAN ONCOLOGY KASEMAN HOSPITAL
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7613
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Country | US
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Telephone | 505-559-6199
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Fax | 505-559-6101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 041965
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License Number State | CT
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