Individual
GARY LYLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1800 SPRING RIDGE DR, SUSANVILLE, CA 96130-6100
(530) 252-2000
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
(602) 747-4577
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2065
CA
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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