MEDICARE: GABRIEL JOHN SMITH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601013267	MI

General Provider Information

NPI Number	:	1316839590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL JOHN SMITH PA-C

Provider Business Mailing Address
First Line	:	7513 COUNTY 527 L RD
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-9109
Country	:	US
Telephone Number	:	906-399-2784
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 US HIGHWAY 2
Second Line	:
City	:	CRYSTAL FALLS
State	:	MI
Zip	:	49920-1045
Country	:	US
Telephone Number	:	906-875-4486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	09/05/2025

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