Healthcare Provider Details

I. General information

NPI: 1376653683
Provider Name (Legal Business Name): LORI LYNNAN SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI LYNNAN KOBRINE MD

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S AIR DEPOT BLVD
MIDWEST CITY OK
73110-4836
US

IV. Provider business mailing address

901 S AIR DEPOT BLVD
MIDWEST CITY OK
73110-4836
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-7818
  • Fax: 57-030-6454
Mailing address:
  • Phone: 405-757-7818
  • Fax: 405-703-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26853
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: