Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 18175 | OK |
NPI | 1003924861 |
---|---|
Provider Name | Dr. Kimberly S Smith |
First Address | Oklahoma City, OK 73120-8347 |
Second Address | Oklahoma City, OK 73120-8347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 26/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100259110C | (05) | OK |
G57874 | (02) | OK |
P00060689 | MEDICARE RR (01) | OK |