Healthcare Provider Details

I. General information

NPI: 1851395412
Provider Name (Legal Business Name): STEPHEN E SMEDLUND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S BRYANT AVE
EDMOND OK
73034-5742
US

IV. Provider business mailing address

910 S BRYANT AVE
EDMOND OK
73034-5742
US

V. Phone/Fax

Practice location:
  • Phone: 405-340-9550
  • Fax: 405-340-4179
Mailing address:
  • Phone: 405-340-9550
  • Fax: 405-340-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13236
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: