Provider Demographics
NPI:1376538454
Name:SMITHTON, COLBI MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:COLBI
Middle Name:MICHELLE
Last Name:SMITHTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:COLBI
Other - Middle Name:MICHELLE
Other - Last Name:GOODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1921 W 6TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4204
Mailing Address - Country:US
Mailing Address - Phone:405-533-2433
Mailing Address - Fax:405-533-2434
Practice Address - Street 1:610 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4222
Practice Address - Country:US
Practice Address - Phone:405-533-1474
Practice Address - Fax:405-742-4990
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3788208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK248226603Medicare ID - Type UnspecifiedMEDICARE NUMBER