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General NPI Number Information
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NPI Number | 1063474344
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Entity Type | Individual
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Provider Name | LONNIE V. SMITH PA
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 4300 W MEMORIAL RD ER DEPT.
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8304
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Country | US
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Telephone | 405-752-3715
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Fax | 405-936-5058
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Provider Business Mailing Address
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Address Line | 2115 PARKVIEW DR
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City | EL RENO
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State | OK
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Zip | 73036-2109
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Country | US
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Telephone | 405-295-1166
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Fax | 405-295-1334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 698
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License Number State | OK
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