Provider Demographics
NPI:1750910600
Name:SMITH, CASEY ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ROBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 VASSAR DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2725
Mailing Address - Country:US
Mailing Address - Phone:505-248-7651
Mailing Address - Fax:505-248-4088
Practice Address - Street 1:MSC (10-5550) 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:DEPT. OF INTERNAL MEDICINE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6331
Practice Address - Fax:505-272-0475
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM390200000X
NMMD2023-0293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program