Provider Demographics
NPI:1376572636
Name:SMILEY, CONSTANCE A (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:A
Last Name:SMILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-752-3162
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:9100 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4417
Practice Address - Country:US
Practice Address - Phone:405-840-4456
Practice Address - Fax:405-840-4295
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK15771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100042850BMedicaid
OK15771OtherLICENSE
OK20167OtherOBNDD
OK080101620OtherRAILROAD
OK20167OtherOBNDD
OKD35286Medicare UPIN