Provider Demographics
NPI:1841291358
Name:MCCRARY-SMITH, GINA MARIA (DO)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIA
Last Name:MCCRARY-SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIA
Other - Last Name:MCCRARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:11645 BISCAYNE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3138
Mailing Address - Country:US
Mailing Address - Phone:305-538-8835
Mailing Address - Fax:305-994-0054
Practice Address - Street 1:11645 BISCAYNE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3139
Practice Address - Country:US
Practice Address - Phone:055-388-8353
Practice Address - Fax:305-994-0054
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019321000Medicaid
MO242927705Medicaid
FL019321000Medicaid
MO242927762OtherNONE