Provider Demographics
NPI:1275822926
Name:SMEDLEY, BRYAN TERRY (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:TERRY
Last Name:SMEDLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10512 N 110TH EAST AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6638
Mailing Address - Country:US
Mailing Address - Phone:918-376-8996
Mailing Address - Fax:918-376-8990
Practice Address - Street 1:10512 N 110TH EAST AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6636
Practice Address - Country:US
Practice Address - Phone:918-376-8996
Practice Address - Fax:918-376-8990
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5118207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery