Doctor Name: | DR. GARRY LEE SMITH |
NPI Number: | 1487937140 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 100150-1 |
Business Practice Address: | 2305 Lake Shore Dr Long Beach, IN - 463601665 |
Business Phone Number: | 2198780870 |
Business Fax Number: | |
Mailing Address: | 2305 Lake Shore Dr, LONG BEACH |
State: | IN |
Postal Code: | 463601665 |
Phone Number: | 2198780870 |
Fax Number: | |
NPI Enumeration Date: | 09/20/2011 |
NPI Last Update Date: | 09/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 100150-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |