Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5118 | OK |
NPI | 1275822926 |
---|---|
Provider Name | Bryan Terry Smedley |
First Address | Owasso, OK 74055-6638 |
Second Address | Owasso, OK 74055-6636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 08/01/2016 |