Healthcare Provider Details

I. General information

NPI: 1598779746
Provider Name (Legal Business Name): GAYLE DIANE SMITH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15622 N HIGHWAY 41
RATHDRUM ID
83858-8710
US

IV. Provider business mailing address

1593 E POLSTON AVE
POST FALLS ID
83854-5326
US

V. Phone/Fax

Practice location:
  • Phone: 208-687-4878
  • Fax: 208-687-4879
Mailing address:
  • Phone: 208-262-2300
  • Fax: 208-262-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-0506
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1943
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: