Provider Demographics
NPI:1376716084
Name:SMITH, GABRIEL GORDON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:GORDON
Last Name:SMITH
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 REDWOOD HWY STE 1204
Practice Address - Street 2:STE 1204
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2483
Practice Address - Country:US
Practice Address - Phone:415-384-4778
Practice Address - Fax:415-384-4779
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2020-10-19
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Provider Licenses
StateLicense IDTaxonomies
GA5325363AM0700X
CA58405363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical