Provider Demographics
NPI:1497715841
Name:SMITH, GARY MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARK
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-734-5400
Mailing Address - Fax:360-715-6996
Practice Address - Street 1:2901 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1851
Practice Address - Country:US
Practice Address - Phone:360-734-5400
Practice Address - Fax:360-715-6996
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000205992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1497715841Medicaid
WA5391145OtherAETNA
WA31601OtherREGENCE
WA1001791Medicaid
WA0178213OtherL&I AND CRIME VICTIMS
WA1497715841Medicaid
A09549Medicare UPIN