Individual
STEPHEN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2500 FARMINGTON AVE, FARMINGTON, NM 87401-4504
(505) 609-2860
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2015-0083
NM
Other
Enumeration date
10/29/2015
Last updated
11/14/2024
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