Healthcare Provider Details

I. General information

NPI: 1033366604
Provider Name (Legal Business Name): GREGORY JAMES SMITH AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3138 KIMBALL AVE
WATERLOO IA
50702-5253
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-4360
  • Fax: 319-235-5360
Mailing address:
  • Phone: 919-308-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1033366604
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: