Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 23307 | OK |
Y | 207Q00000X | Family Doctor | 23307 | OK |
NPI | 1023008653 |
---|---|
Provider Name | Dr. Kirk M. Smith |
First Address | Lawton, OK 73501-8705 |
Second Address | Lawton, OK 73501-8705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 08/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200019910A | (05) | OK |
800522535 | MEDICARE GROUP PIN (01) | OK |
H25948 | (02) |