Healthcare Provider Details

I. General information

NPI: 1891794715
Provider Name (Legal Business Name): RAYMOND LEE SMITH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 E 9TH ST
EDMOND OK
73034-5712
US

IV. Provider business mailing address

4900 S MONACO ST #210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-8538
  • Fax: 405-285-8539
Mailing address:
  • Phone: 405-285-8538
  • Fax: 405-285-8539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number178
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number178
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: