Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2833 | OK |
NPI | 1083660369 |
---|---|
Provider Name | Dale B Smith |
First Address | Lawton, OK 73505-8339 |
Second Address | Lawton, OK 73505-8339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 12/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F24115 | (02) | OK |