Provider Demographics
NPI:1063007557
Name:SMETHERS, GARY DRUE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DRUE
Last Name:SMETHERS
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 1:3634 7TH AVE UNIT 8BC
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4342
Mailing Address - Country:US
Mailing Address - Phone:602-908-9190
Mailing Address - Fax:
Practice Address - Street 1:3634 7TH AVE UNIT 8BC
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4342
Practice Address - Country:US
Practice Address - Phone:602-908-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine