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General NPI Number Information
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NPI Number | 1881951366
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Entity Type | Individual
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Provider Name | BRIAN GOFF SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | MSC 09 5040 1 UNIVERSITY OF NEW MEXICO
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-0001
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Country | US
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Telephone | 505-272-6607
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Fax |
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Provider Business Mailing Address
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Address Line | 1035 ALTO ST
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City | SANTA FE
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State | NM
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Zip | 87501-2406
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Country | US
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Telephone | 505-982-4425
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NM2015-074
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License Number State | NM
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