Individual
GERRITT F SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 423-6690
(765) 423-6691
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01033525A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000110550
ANTHEM PROVIDER NUMBER
IN
05
—
200009780
—
IN
Enumeration date
03/28/2006
Last updated
09/14/2023
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