MEDICARE: MS. CINDY L SMITH L.O., L.PED

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	174400000X	Specialist	LO 20, L.PED 27	OK

General Provider Information

NPI Number	:	1922001379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CINDY L SMITH L.O., L.PED

Provider Business Mailing Address
First Line	:	8121 S WESTERN AVE
Second Line	:	STE I
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2546
Country	:	US
Telephone Number	:	405-366-0184
Fax Number	:	405-604-6818

Provider Business Practice Location Address
First Line	:	8121 S WESTERN AVE
Second Line	:	STE I
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2546
Country	:	US
Telephone Number	:	405-366-0184
Fax Number	:	405-604-6818

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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