Basic Information
| Provider Information | |||||||||
| NPI: | 1619184652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREGG SMITH D.O., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1042 N HIGLEY RD | ||||||||
| Address2: | SUITE 102-602 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852055398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802426297 | ||||||||
| FaxNumber: | 4806993129 | ||||||||
| Practice Location | |||||||||
| Address1: | 1042 N HIGLEY RD | ||||||||
| Address2: | SUITE 102-602 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852055398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802426297 | ||||||||
| FaxNumber: | 4806993129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 04/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4802426297 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 2813 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 318198 | 05 | AZ | MEDICAID |