Provider Demographics
NPI:1285773614
Name:SMITH, ROBERT THOMAS (DN)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FIRST PLAZA CTR NW
Mailing Address - Street 2:SUITE # 62
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3355
Mailing Address - Country:US
Mailing Address - Phone:505-242-4800
Mailing Address - Fax:505-242-4849
Practice Address - Street 1:40 FIRST PLAZA CTR NW
Practice Address - Street 2:SUITE # 62
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3355
Practice Address - Country:US
Practice Address - Phone:505-242-4800
Practice Address - Fax:505-242-4849
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0016172P00000X
IL181-000293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
No174400000XOther Service ProvidersSpecialist