MEDICARE: JOSEPH M. SMITH III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	93154	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700521083	OTHER		MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1437103157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH M. SMITH III MD

Provider Business Mailing Address
First Line	:	19420 N 59TH AVE
Second Line	:	SUITE B233
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6894
Country	:	US
Telephone Number	:	623-234-2542
Fax Number	:	623-234-2543

Provider Business Practice Location Address
First Line	:	490B W ZIA RD
Second Line	:	SUITE A
City	:	SANTA FE
State	:	NM
Zip	:	87505-6996
Country	:	US
Telephone Number	:	505-995-8346
Fax Number	:	505-995-8345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/11/2012

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