Healthcare Provider Details

I. General information

NPI: 1134105059
Provider Name (Legal Business Name): FRANK JAY SMITH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 KERR AVE
POTEAU OK
74953-5270
US

IV. Provider business mailing address

10801 OKLAHOMA ROAD
HACKETT AR
72937
US

V. Phone/Fax

Practice location:
  • Phone: 918-649-1100
  • Fax:
Mailing address:
  • Phone: 479-312-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA03545
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA982
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: