Provider Demographics
NPI:1932111895
Name:SMITH, LINDA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8020 CONSTITUTION PL NE
Mailing Address - Street 2:STE 202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7640
Mailing Address - Country:US
Mailing Address - Phone:505-559-5628
Mailing Address - Fax:505-998-3100
Practice Address - Street 1:101 HOSPITAL LOOP NE
Practice Address - Street 2:SUITE 106
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2129
Practice Address - Country:US
Practice Address - Phone:505-828-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83-302208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61708089Medicaid
NM33563Medicare ID - Type Unspecified