Healthcare Provider Details

I. General information

NPI: 1124556519
Provider Name (Legal Business Name): BRETT MATTHEW SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 N PORTLAND AVE
OKLAHOMA CITY OK
73120-5045
US

IV. Provider business mailing address

1101 HEMSTEAD PL
NICHOLS HILLS OK
73116-6210
US

V. Phone/Fax

Practice location:
  • Phone: 405-936-1500
  • Fax:
Mailing address:
  • Phone: 918-698-6787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number38045
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: