Provider Demographics
NPI:1134716921
Name:GARY L. SMOOT, M.D., P.A.
Entity type:Organization
Organization Name:GARY L. SMOOT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:PITTMAN
Authorized Official - Last Name:SMOOT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:919-444-1577
Mailing Address - Street 1:260 SKY LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-6638
Mailing Address - Country:US
Mailing Address - Phone:919-444-1577
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty