Healthcare Provider Details

I. General information

NPI: 1629112636
Provider Name (Legal Business Name): TOTAL FOOT AND ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NW 56TH ST SUITE 600
OKLAHOMA CITY OK
73112-4479
US

IV. Provider business mailing address

3330 NW 56TH ST SUITE 600
OKLAHOMA CITY OK
73112-4479
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-8041
  • Fax: 405-947-8043
Mailing address:
  • Phone: 405-947-8041
  • Fax: 405-947-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number244
License Number StateOK

VIII. Authorized Official

Name: GUY TRENT SMITH
Title or Position: OWNER
Credential: DPM
Phone: 405-947-8041