Healthcare Provider Details

I. General information

NPI: 1912083494
Provider Name (Legal Business Name): JEFFREY J SMITH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13128 N MACARTHUR
OKLAHOMA CITY OK
73142-3017
US

IV. Provider business mailing address

13128 N MACARTHUR
OKLAHOMA CITY OK
73142-3017
US

V. Phone/Fax

Practice location:
  • Phone: 405-470-6767
  • Fax: 405-470-6768
Mailing address:
  • Phone: 405-470-6767
  • Fax: 405-470-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number14140
License Number StateOK

VIII. Authorized Official

Name: JEFFREY J SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 405-470-6767