Healthcare Provider Details

I. General information

NPI: 1053316745
Provider Name (Legal Business Name): JAMES W SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 03/15/2023
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN FL 5
ROGERS AR
72758-1452
US

IV. Provider business mailing address

4140 W MEMORIAL RD STE 321
OKLAHOMA CITY OK
73120-8300
US

V. Phone/Fax

Practice location:
  • Phone: 405-748-4726
  • Fax: 405-607-8497
Mailing address:
  • Phone: 405-748-4726
  • Fax: 405-607-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberJ7851
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE12087
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: