Provider Demographics
NPI:1083660369
Name:SMITH, DALE B (DO)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8339
Mailing Address - Country:US
Mailing Address - Phone:580-536-8844
Mailing Address - Fax:580-536-8818
Practice Address - Street 1:4920 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8339
Practice Address - Country:US
Practice Address - Phone:580-536-8844
Practice Address - Fax:580-536-8818
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2833207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK249615101Medicare PIN
OKF24115Medicare UPIN