Healthcare Provider Details

I. General information

NPI: 1801885371
Provider Name (Legal Business Name): GARY O SMOTHERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S LINDEN RD
FLINT MI
48532-3456
US

IV. Provider business mailing address

401 S BALLENGER HWY
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 810-342-1700
  • Fax: 810-720-4035
Mailing address:
  • Phone: 810-342-1000
  • Fax: 810-342-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101008388
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: