Individual
DR. ROY SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 469-6610
(260) 969-3065
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02008577A
IN
207Q00000X
Family Medicine Physician
5101010809
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M74750684
PIN
MI
Enumeration date
05/23/2006
Last updated
11/03/2025
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