Provider Demographics
NPI:1558335612
Name:SMOOT, GARY LOWELL (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LOWELL
Last Name:SMOOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1091 PEMBERTON HILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4269
Mailing Address - Country:US
Mailing Address - Phone:919-444-8800
Mailing Address - Fax:919-336-4568
Practice Address - Street 1:1091 PEMBERTON HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4269
Practice Address - Country:US
Practice Address - Phone:919-444-8800
Practice Address - Fax:919-336-4568
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC34163208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
E90415Medicare UPIN