Provider Demographics
NPI:1700883394
Name:SMALTZ, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:SMALTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 MEDICAL DRIVE COMPLEX A, STE. 103
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-2539
Mailing Address - Country:US
Mailing Address - Phone:505-437-4909
Mailing Address - Fax:505-437-4953
Practice Address - Street 1:2539 MEDICAL DR COMPLEX A, STE 103
Practice Address - Street 2:ALAMOGORDO UROLOGY
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8720
Practice Address - Country:US
Practice Address - Phone:575-437-4909
Practice Address - Fax:575-437-4953
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2021-08-30
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
NM2001-312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG7222Medicaid
NMG7222Medicaid