Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 14140 | OK |
NPI | 1184675860 |
---|---|
Provider Name | Dr. Jeffrey J Smith |
First Address | Edmond, OK 73083-5645 |
Second Address | Edmond, OK 73013-3023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 09/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100826770B | (05) | OK |
E11710 | (02) | OK |