Provider Demographics
NPI:1154328862
Name:GARANT-SMOTHERMAN, MICHELE LEANNE (DO)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEANNE
Last Name:GARANT-SMOTHERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 STATE HWY 47
Mailing Address - Street 2:STE 3115
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-8306
Mailing Address - Country:US
Mailing Address - Phone:979-436-9703
Mailing Address - Fax:979-693-7442
Practice Address - Street 1:1602 ROCK PRAIRIE RD STE 3400
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5992
Practice Address - Country:US
Practice Address - Phone:979-693-0737
Practice Address - Fax:979-693-7442
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1Z4295OtherTAMU PTAN
TX081516902Medicaid
TX00A13WMedicare ID - Type Unspecified