Healthcare Provider Details

I. General information

NPI: 1184675860
Provider Name (Legal Business Name): JEFFREY J SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RENAISSANCE BLVD STE 210
EDMOND OK
73013-3023
US

IV. Provider business mailing address

PO BOX 5645
EDMOND OK
73083-5645
US

V. Phone/Fax

Practice location:
  • Phone: 405-470-6767
  • Fax: 405-470-6768
Mailing address:
  • Phone: 405-470-6767
  • Fax: 405-470-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14140
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number14140
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: