Provider Demographics
NPI:1548569726
Name:SMITH, LLOYD NATHAN
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:NATHAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S UTICA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5346
Mailing Address - Country:US
Mailing Address - Phone:918-748-7557
Mailing Address - Fax:918-403-0383
Practice Address - Street 1:1717 S UTICA AVE STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5346
Practice Address - Country:US
Practice Address - Phone:918-748-7557
Practice Address - Fax:918-403-0383
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine