Provider Demographics
NPI:1932774650
Name:SMITH, MICHAEL JACOBY (MD, MPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JACOBY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, MPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 CECILIA ST # A
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7120
Mailing Address - Country:US
Mailing Address - Phone:575-288-0741
Mailing Address - Fax:
Practice Address - Street 1:3185 N LESLIE RD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7211
Practice Address - Country:US
Practice Address - Phone:575-388-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76-0128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty