Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1427586098 |
---|---|
Provider Name | Todd C Smith |
First Address | Ardmore, OK 73401-2354 |
Second Address | Ardmore, OK 73401-2354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2017 |
Last Update Date | 13/10/2017 |