MEDICARE: DR. JEFFREY J SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	14140	OK
2	174400000X	Specialist	14140	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184675860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY J SMITH MD

Provider Business Mailing Address
First Line	:	PO BOX 5645
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73083-5645
Country	:	US
Telephone Number	:	405-470-6767
Fax Number	:	405-470-6768

Provider Business Practice Location Address
First Line	:	1800 RENAISSANCE BLVD
Second Line	:	STE 210
City	:	EDMOND
State	:	OK
Zip	:	73013-3023
Country	:	US
Telephone Number	:	405-470-6767
Fax Number	:	405-470-6768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	01/09/2019

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