Healthcare Provider Details

I. General information

NPI: 1598788515
Provider Name (Legal Business Name): CARL ROE SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39785 W HIGHWAY 16
BRISTOW OK
74010-8588
US

IV. Provider business mailing address

700 W 7TH AVE SUITE 101
BRISTOW OK
74010-2302
US

V. Phone/Fax

Practice location:
  • Phone: 918-729-3850
  • Fax:
Mailing address:
  • Phone: 918-367-3272
  • Fax: 918-367-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3992
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: