Healthcare Provider Details

I. General information

NPI: 1740215169
Provider Name (Legal Business Name): DAVID L SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 E 33RD ST
EDMOND OK
73013-6307
US

IV. Provider business mailing address

DEPT 960321
OKLAHOMA CITY OK
73196-0321
US

V. Phone/Fax

Practice location:
  • Phone: 405-813-2600
  • Fax: 405-813-2633
Mailing address:
  • Phone: 405-292-5500
  • Fax: 405-292-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number24638
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: