Provider Demographics
NPI:1427366426
Name:SMELTZER, CARY LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:LYNN
Last Name:SMELTZER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:CARY
Other - Middle Name:LYNN
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:13500 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95415-9133
Mailing Address - Country:US
Mailing Address - Phone:707-895-3477
Mailing Address - Fax:707-895-2035
Practice Address - Street 1:13500 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95415-9133
Practice Address - Country:US
Practice Address - Phone:707-895-3477
Practice Address - Fax:707-895-2035
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005614390200000X
390200000X
CA20A12450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program