Healthcare Provider Details

I. General information

NPI: 1316529225
Provider Name (Legal Business Name): AUSTIN SMITH IVY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

V. Phone/Fax

Practice location:
  • Phone: 316-259-2495
  • Fax:
Mailing address:
  • Phone: 573-429-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number43359
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2024032187
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV1494
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43359
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA184013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: