Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 18860 | OK |
NPI | 1043265770 |
---|---|
Provider Name | Dr. Kent Ragan Smalley |
First Address | Edmond, OK 73012-9150 |
Second Address | Edmond, OK 73012-9150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 29/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100094690A | (05) | OK |
G000716 | (02) | OK |