Provider Demographics
NPI:1972601078
Name:SMITH, GARY VALDEMAR (PA)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:VALDEMAR
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6244
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00804-6244
Mailing Address - Country:US
Mailing Address - Phone:340-774-9172
Mailing Address - Fax:
Practice Address - Street 1:9048 SUGAR ESTATE
Practice Address - Street 2:ROY LESTER SCHNEIDER MEDICAL CENTER
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-776-8311
Practice Address - Fax:340-714-6322
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI239782300000013OtherPHYSICIAN ASSISTANT