Healthcare Provider Details

I. General information

NPI: 1699863399
Provider Name (Legal Business Name): METRO TULSA FOOT & ANKLE SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10229 E 96TH ST N SUITE 100
OWASSO OK
74055-5305
US

IV. Provider business mailing address

PO BOX 268860
OKLAHOMA CITY OK
73126-8860
US

V. Phone/Fax

Practice location:
  • Phone: 918-272-8920
  • Fax: 918-272-8922
Mailing address:
  • Phone: 918-272-8920
  • Fax: 918-272-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number200
License Number StateOK

VIII. Authorized Official

Name: DR. STEVEN BRIAN SMITH
Title or Position: OWNER
Credential: DPM
Phone: 918-494-2902