Healthcare Provider Details

I. General information

NPI: 1316005333
Provider Name (Legal Business Name): ROBERT LOUIS SMITH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 S MINGO RD SUITE 200
TULSA OK
74133-5718
US

IV. Provider business mailing address

9228 S MINGO RD SUITE 200
TULSA OK
74133-5718
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax: 918-392-0346
Mailing address:
  • Phone: 918-592-0999
  • Fax: 918-392-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberTRN10606
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25567
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: