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General NPI Number Information
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NPI Number | 1316839590
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Entity Type | Individual
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Provider Name | GABRIEL JOHN SMITH PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 1328 US HIGHWAY 2
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City | CRYSTAL FALLS
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State | MI
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Zip | 49920-1045
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Country | US
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Telephone | 906-875-4486
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Fax |
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Provider Business Mailing Address
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Address Line | 7513 COUNTY 527 L RD
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City | GLADSTONE
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State | MI
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Zip | 49837-9109
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Country | US
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Telephone | 906-399-2784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601013267
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License Number State | MI
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