Provider Demographics
NPI:1801885371
Name:SMOTHERS, GARY O (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:O
Last Name:SMOTHERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:1314 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3456
Practice Address - Country:US
Practice Address - Phone:810-342-1700
Practice Address - Fax:810-720-4035
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080093094OtherMETRAHEALTH
MI080D410020OtherBLUE CARE NETWORK
MIB47870OtherHEALTH NET SERVICES
MI0450162003OtherCIGNA
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI4335474OtherAETNA
MI0882500135OtherHEALTH PLUS
MI204396OtherMCLAREN HEALTH PLAN
MI204396OtherHEALTH ADVANTAGE NETWORK
MIB47870OtherHEALTH ALLIANCE PLAN
MIC1600OtherMCARE
MI0852500134OtherBLUE CROSS BLUE SHIELD
MI4386823Medicaid
MI080093094OtherMETRAHEALTH
MI204396OtherMCLAREN HEALTH PLAN
MI080D410020OtherBLUE CARE NETWORK
MI4335474OtherAETNA