Provider Demographics
NPI:1528075579
Name:SMITH, ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-5504
Practice Address - Fax:505-272-1669
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-07-02
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Provider Licenses
StateLicense IDTaxonomies
NM87-350208800000X, 204F00000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C21990Medicare UPIN