Provider Demographics
NPI:1780663369
Name:SMITH, FREDRICA E (MD)
Entity Type:Individual
Prefix:
First Name:FREDRICA
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3917 WEST ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544
Mailing Address - Country:US
Mailing Address - Phone:505-662-9400
Mailing Address - Fax:505-662-3148
Practice Address - Street 1:3917 WEST ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544
Practice Address - Country:US
Practice Address - Phone:505-662-9400
Practice Address - Fax:505-662-3148
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMNM7369207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM26005Medicaid
NM26005Medicaid
NM2123358Medicare PIN