Provider Demographics
NPI:1669587630
Name:SMITH, GARRETT B (DO)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N 2000 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4047
Mailing Address - Country:US
Mailing Address - Phone:801-756-3511
Mailing Address - Fax:801-756-1705
Practice Address - Street 1:275 W 200 N
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1809
Practice Address - Country:US
Practice Address - Phone:801-796-1333
Practice Address - Fax:801-443-1164
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT57067131204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107031736101OtherSELECTHEALTH
UT870293873GBSOtherEMI HEALTH
UTIDX35650Medicaid
UT57067131202001OtherBLUE CROSS
UT908424OtherDESERET HEALTHCARE TRUST
UT225991OtherALTIUS
UT87029387384062A003OtherTRICARE
UTD5969Medicaid
UT80400OtherPEHP
UT80400OtherPEHP
UT225991OtherALTIUS
UTIDX35650Medicaid