Basic Information
| Provider Information | |||||||||
| NPI: | 1306951637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | LANETTE | ||||||||
| MiddleName: | FAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 S YALE AVE | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184886001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6475 S YALE AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185855658 | ||||||||
| FaxNumber: | 9185855670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 19498 | OK | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100126430B | 05 | OK | MEDICAID |