Healthcare Provider Details

I. General information

NPI: 1891745030
Provider Name (Legal Business Name): MARTIN J SMOLIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W GORE BLVD
LAWTON OK
73505-6332
US

IV. Provider business mailing address

PO BOX 2309 SECTION 4
LAWTON OK
73502
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-8620
  • Fax:
Mailing address:
  • Phone: 800-627-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number38195
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR5J51
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15705
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: