Basic Information
| Provider Information | |||||||||
| NPI: | 1154328862 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARANT-SMOTHERMAN | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | LEANNE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8441 STATE HWY 47 | ||||||||
| Address2: | STE 3115 | ||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778078306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9794369703 | ||||||||
| FaxNumber: | 9796937442 | ||||||||
| Practice Location | |||||||||
| Address1: | 1602 ROCK PRAIRIE RD STE 3400 | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778455992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9796930737 | ||||||||
| FaxNumber: | 9796937442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | L9695 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1Z4295 | 01 | TX | TAMU PTAN | OTHER | 081516902 | 05 | TX | MEDICAID |