Healthcare Provider Details

I. General information

NPI: 1174610315
Provider Name (Legal Business Name): METRO TULSA FOOT & ANKLE SPECIALIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 E 71ST ST SUITE 115
TULSA OK
74136-6628
US

IV. Provider business mailing address

5711 E 71ST ST SUITE 115
TULSA OK
74136-6628
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-2902
  • Fax: 918-494-2905
Mailing address:
  • Phone: 918-494-2902
  • Fax: 918-494-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number186
License Number StateOK

VIII. Authorized Official

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