Basic Information
| Provider Information | |||||||||
| NPI: | 1912083494 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY J SMITH MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13128 N MACARTHUR | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731423017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054706767 | ||||||||
| FaxNumber: | 4054706768 | ||||||||
| Practice Location | |||||||||
| Address1: | 13128 N MACARTHUR | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731423017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054706767 | ||||||||
| FaxNumber: | 4054706768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 06/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4054706767 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 14140 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 200007030A | 05 | OK | MEDICAID |