MEDICARE: DR. GARY O SMOTHERS DO

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101008388	MI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080093094	OTHER	MI	METRAHEALTH
2	080D410020	OTHER	MI	BLUE CARE NETWORK
3	B47870	OTHER	MI	HEALTH NET SERVICES
4	0450162003	OTHER	MI	CIGNA
5	080D410020	OTHER	MI	BLUE CROSS BLUE SHIELD
6	4335474	OTHER	MI	AETNA
7	0882500135	OTHER	MI	HEALTH PLUS
8	204396	OTHER	MI	MCLAREN HEALTH PLAN
9	204396	OTHER	MI	HEALTH ADVANTAGE NETWORK
10	B47870	OTHER	MI	HEALTH ALLIANCE PLAN
11	C1600	OTHER	MI	MCARE
12	0852500134	OTHER	MI	BLUE CROSS BLUE SHIELD
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1801885371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY O SMOTHERS DO

Provider Business Mailing Address
First Line	:	401 S BALLENGER HWY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3638
Country	:	US
Telephone Number	:	810-342-1000
Fax Number	:	810-342-1590

Provider Business Practice Location Address
First Line	:	1314 S LINDEN RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3456
Country	:	US
Telephone Number	:	810-342-1700
Fax Number	:	810-720-4035

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	09/15/2011

1314 S LINDEN RD STE A
FLINT, MI
48532-3456

Practice Phone: 810-342-1750
Practice Fax: