Provider Demographics
NPI:1487677381
Name:SMITH, STANLEY JOE (DO)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JOE
Last Name:SMITH
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:DT 1000
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-403-7054
Mailing Address - Fax:918-744-2946
Practice Address - Street 1:13600 E 86TH ST N
Practice Address - Street 2:STE 100
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8731
Practice Address - Country:US
Practice Address - Phone:918-272-9313
Practice Address - Fax:918-403-6311
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-02-04
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Provider Licenses
StateLicense IDTaxonomies
OK2232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE09774Medicare UPIN