MEDICARE: JENNIFER G SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	28110	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	80768	OTHER	PARTNERS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7959719	OTHER	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1391R	OTHER	BCBS
6	E4094	OTHER	MEDCOST

General Provider Information

NPI Number	:	1265417687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER G SMITH MD

Provider Business Mailing Address
First Line	:	4140 W MEMORIAL RD
Second Line	:	SUITE 321
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8366
Country	:	US
Telephone Number	:	405-748-4726
Fax Number	:	405-607-8497

Provider Business Practice Location Address
First Line	:	4140 W MEMORIAL RD
Second Line	:	SUITE 321
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8366
Country	:	US
Telephone Number	:	405-748-4726
Fax Number	:	405-607-8497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	01/10/2020

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Directions to “ JENNIFER G SMITH MD” Practice Location

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