Provider Demographics
NPI:1376653683
Name:SMITH, LORI LYNNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LYNNAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LYNNAN
Other - Last Name:KOBRINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:901 S AIR DEPOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4836
Mailing Address - Country:US
Mailing Address - Phone:405-757-7818
Mailing Address - Fax:405-703-0645
Practice Address - Street 1:901 S AIR DEPOT BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4836
Practice Address - Country:US
Practice Address - Phone:405-757-7818
Practice Address - Fax:057-030-6454
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26853208000000X
MT8734208000000X
CODR.0037558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000119056Medicaid