Provider Demographics
NPI:1437103157
Name:SMITH, JOSEPH M III (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:SMITH
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:19420 N 59TH AVE
Mailing Address - Street 2:SUITE B233
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6894
Mailing Address - Country:US
Mailing Address - Phone:623-234-2542
Mailing Address - Fax:623-234-2543
Practice Address - Street 1:490B W ZIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6996
Practice Address - Country:US
Practice Address - Phone:505-995-8346
Practice Address - Fax:505-995-8345
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-06-11
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Provider Licenses
StateLicense IDTaxonomies
NM931542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
700521083OtherMEDICARE GROUP NUMBER
700521083OtherMEDICARE GROUP NUMBER
A73068Medicare UPIN