Healthcare Provider Details

I. General information

NPI: 1083164438
Provider Name (Legal Business Name): CHRISTOPHER SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 AIR DEPOT BLVD BLDG 1094
TINKER AFB OK
73145-8716
US

IV. Provider business mailing address

1200 WHISPERING GLEN ST
TECUMSEH OK
74873-1637
US

V. Phone/Fax

Practice location:
  • Phone: 405-582-6603
  • Fax: 405-736-3357
Mailing address:
  • Phone: 405-802-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7082
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: