Provider Demographics
NPI:1073506531
Name:SMITH, KENNETH J (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8300 CONSTITUTION AVE. NE
Mailing Address - Street 2:PRESBYTERIAN ONCOLOGY KASEMAN HOSPITAL
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7613
Mailing Address - Country:US
Mailing Address - Phone:505-559-6199
Mailing Address - Fax:505-559-6101
Practice Address - Street 1:8300 CONSTITUTION AVE. NE
Practice Address - Street 2:PRESBYTERIAN ONCOLOGY KASEMAN HOSPITAL
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-559-6199
Practice Address - Fax:505-559-6101
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT041965207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2V5874OtherHEALTHNET
CT010041965CT03OtherANTHEM BCBS
CT001419656Medicaid
CT041965OtherCONNECTICARE
P3157657OtherOXFORD
2V5874OtherHEALTHNET
CT041965OtherCONNECTICARE
P3157657OtherOXFORD