Healthcare Provider Details

I. General information

NPI: 1104489699
Provider Name (Legal Business Name): GABRIELLA LYNNE SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 S RESEARCH DR
TEMPE AZ
85284-1812
US

IV. Provider business mailing address

7695 S RESEARCH DR
TEMPE AZ
85284-1812
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-1664
  • Fax:
Mailing address:
  • Phone: 480-256-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number80921
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: