Provider Demographics
NPI:1275924516
Name:SMITH, STEVEN I
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SMITH
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-2616
Mailing Address - Country:US
Mailing Address - Phone:405-268-2120
Mailing Address - Fax:
Practice Address - Street 1:109 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-3833
Practice Address - Country:US
Practice Address - Phone:405-238-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist