Individual
CHRISTIAN TYLER SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
601 DR MARTIN LUTHER KING JR AVE NE, ALBUQUERQUE, NM 87102-3619
(505) 727-8360
Mailing address
601 DR MARTIN LUTHER KING JR AVE NE, ALBUQUERQUE, NM 87102-3619
(505) 727-8360
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO2024-0037
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO2024-0037
NM LICENSE
NM
Enumeration date
04/15/2021
Last updated
07/03/2024
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