Provider Demographics
NPI:1821005935
Name:GARY A SMITH, MD, PLLC
Entity Type:Organization
Organization Name:GARY A SMITH, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-279-0457
Mailing Address - Street 1:7400 S POWER RD
Mailing Address - Street 2:BLDG. 5, STE. 120
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9281
Mailing Address - Country:US
Mailing Address - Phone:480-988-1659
Mailing Address - Fax:480-988-1871
Practice Address - Street 1:7400 S POWER RD
Practice Address - Street 2:BLDG. 5, STE. 120
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9281
Practice Address - Country:US
Practice Address - Phone:480-988-1659
Practice Address - Fax:480-988-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69347Medicare PIN