Healthcare Provider Details

I. General information

NPI: 1134716921
Provider Name (Legal Business Name): GARY L. SMOOT, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 PEMBERTON HILL RD STE 101
APEX NC
27502-4269
US

IV. Provider business mailing address

260 SKY LN
PITTSBORO NC
27312-6638
US

V. Phone/Fax

Practice location:
  • Phone: 919-444-8800
  • Fax: 919-336-4568
Mailing address:
  • Phone: 919-444-1577
  • Fax: 919-336-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA PITTMAN SMOOT
Title or Position: PRACTICE MANAGER
Credential: FNP
Phone: 919-444-1577