Healthcare Provider Details

I. General information

NPI: 1487677381
Provider Name (Legal Business Name): STANLEY JOE SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13600 E 86TH ST N STE 100
OWASSO OK
74055-8731
US

IV. Provider business mailing address

1923 S UTICA AVE DT 1000
TULSA OK
74104
US

V. Phone/Fax

Practice location:
  • Phone: 918-272-9313
  • Fax: 918-403-6311
Mailing address:
  • Phone: 918-403-7054
  • Fax: 918-744-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2232
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: