MEDICARE: GARY A SMITH M.D.

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	207Q00000X	Family Medicine Physician	27779	AZ

General Provider Information

NPI Number	:	1538126487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY A SMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 52992
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85208-0150
Country	:	US
Telephone Number	:	480-373-2399
Fax Number	:	480-373-2396

Provider Business Practice Location Address
First Line	:	5656 S POWER RD
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-8480
Country	:	US
Telephone Number	:	480-373-2399
Fax Number	:	480-373-2396

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	02/27/2025

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