Healthcare Provider Details

I. General information

NPI: 1578604989
Provider Name (Legal Business Name): CHAD MICHAEL SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH SUITE 3300
OKLA CITY OK
73104
US

IV. Provider business mailing address

920 STANTON L. YOUNG WP 2430
OKLA CITY OK
73104
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5239
  • Fax: 405-271-3727
Mailing address:
  • Phone: 405-271-7449
  • Fax: 405-271-8762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25014
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: