MEDICARE: GARY WILLIAM SMALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G43707	CA
2	2084P0800X	Psychiatry Physician	25MA10957900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295842946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY WILLIAM SMALL

Provider Business Mailing Address
First Line	:	10780 SANTA MONICA BLVD STE 450
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7635
Country	:	US
Telephone Number	:	310-237-1070
Fax Number	:	424-447-0031

Provider Business Practice Location Address
First Line	:	10780 SANTA MONICA BLVD STE 450
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7635
Country	:	US
Telephone Number	:	310-237-1070
Fax Number	:	424-447-0031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	04/06/2026

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Directions to “ GARY WILLIAM SMALL ” Practice Location

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