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General NPI Number Information
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NPI Number | 1619184652
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Entity Type | Organization
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Legal Business Name | GREGG SMITH D.O., P.C.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 1042 N HIGLEY RD SUITE 102-602
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City | MESA
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State | AZ
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Zip | 85205-5398
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Country | US
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Telephone | 480-242-6297
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Fax | 480-699-3129
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Provider Business Mailing Address
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Address Line | 1042 N HIGLEY RD SUITE 102-602
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City | MESA
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State | AZ
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Zip | 85205-5398
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Country | US
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Telephone | 480-242-6297
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Fax | 480-699-3129
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Authorized Official
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Title or Position | OWNER
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Name | GREGG A SMITH
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Credential | D.O.
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Telephone | 480-242-6297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2813
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License Number State | AZ
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