Provider Demographics
NPI:1902174758
Name:GARY D. SMALL DPM CORP
Entity Type:Organization
Organization Name:GARY D. SMALL DPM CORP
Other - Org Name:CORAL GABLES PODIATRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-444-7114
Mailing Address - Street 1:2645 SW 37TH AVE
Mailing Address - Street 2:SUITE 704
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2754
Mailing Address - Country:US
Mailing Address - Phone:305-444-7114
Mailing Address - Fax:305-444-9587
Practice Address - Street 1:2645 SW 37TH AVE
Practice Address - Street 2:SUITE 704
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2754
Practice Address - Country:US
Practice Address - Phone:305-444-7114
Practice Address - Fax:305-444-9587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY D. SMALL DPM CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-08
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site