Provider Demographics
NPI:1104814607
Name:SMITH, FILIZ A (MD)
Entity type:Individual
Prefix:
First Name:FILIZ
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29329
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-9329
Mailing Address - Country:US
Mailing Address - Phone:505-316-3157
Mailing Address - Fax:
Practice Address - Street 1:333 MONTANO RD NW STE A1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5200
Practice Address - Country:US
Practice Address - Phone:505-777-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO57446207Q00000X
UT9112874-1205207Q00000X
NMMD2018-0182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G32547Medicare UPIN
FL379288900Medicaid
FL28199Medicare ID - Type Unspecified