Healthcare Provider Details

I. General information

NPI: 1619184652
Provider Name (Legal Business Name): GREGG SMITH D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 N HIGLEY RD SUITE 102-602
MESA AZ
85205-5398
US

IV. Provider business mailing address

1042 N HIGLEY RD SUITE 102-602
MESA AZ
85205-5398
US

V. Phone/Fax

Practice location:
  • Phone: 480-242-6297
  • Fax: 480-699-3129
Mailing address:
  • Phone: 480-242-6297
  • Fax: 480-699-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2813
License Number StateAZ

VIII. Authorized Official

Name: GREGG A SMITH
Title or Position: OWNER
Credential: D.O.
Phone: 480-242-6297