Healthcare Provider Details

I. General information

NPI: 1427019488
Provider Name (Legal Business Name): DAVID WILLIAM SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE SUITE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 405-951-2541
  • Fax: 405-951-2237
Mailing address:
  • Phone: 405-951-2541
  • Fax: 405-951-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number21506
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: