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General NPI Number Information
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NPI Number | 1518931666
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Entity Type | Organization
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Legal Business Name | CAROLINA SPINE SPECIALISTS PA
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 4030 WAKE FOREST RD SUITE 102
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City | RALEIGH
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State | NC
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Zip | 27609
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Country | US
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Telephone | 919-873-0002
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Fax | 919-873-0006
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Provider Business Mailing Address
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Address Line | 4030 WAKE FOREST RD SUITE 102
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City | RALEIGH
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State | NC
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Zip | 27609
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Country | US
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Telephone | 919-873-0002
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Fax | 919-873-0006
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | GARY LOWELL SMOOT
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Credential | MD
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Telephone | 919-873-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 34163
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License Number State | NC
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