MEDICARE: MARCUS JOHN 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	207R00000X	Internal Medicine Physician	25706	OK
2	207RI0011X	Interventional Cardiology Physician	25706	OK
3	207RC0000X	Cardiovascular Disease Physician	25706	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	:	1578769055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS JOHN SMITH MD

Provider Business Mailing Address
First Line	:	3200 QUAIL SPRINGS PKWY
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2604
Country	:	US
Telephone Number	:	405-701-9880
Fax Number	:	405-701-9881

Provider Business Practice Location Address
First Line	:	3200 QUAIL SPRINGS PKWY
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2604
Country	:	US
Telephone Number	:	405-701-9880
Fax Number	:	405-701-9881

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	03/13/2017

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