Provider Demographics
NPI:1437134657
Name:SMALLWOOD RYAN, KAREN GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:GAIL
Last Name:SMALLWOOD RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:GAIL
Other - Last Name:SMALLWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7820 E 15TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-7832
Mailing Address - Country:US
Mailing Address - Phone:918-622-6606
Mailing Address - Fax:573-339-7946
Practice Address - Street 1:7820 E 15TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-7832
Practice Address - Country:US
Practice Address - Phone:918-622-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1183362083X0100X
OK186882083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F86699Medicare UPIN