Healthcare Provider Details

I. General information

NPI: 1275822926
Provider Name (Legal Business Name): BRYAN TERRY SMEDLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10512 N 110TH EAST AVE SUITE 210
OWASSO OK
74055-6636
US

IV. Provider business mailing address

10512 N 110TH EAST AVE STE 200
OWASSO OK
74055-6638
US

V. Phone/Fax

Practice location:
  • Phone: 918-376-8996
  • Fax: 918-376-8990
Mailing address:
  • Phone: 918-376-8996
  • Fax: 918-376-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5118
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: