Provider Demographics
NPI:1558477927
Name:SMITH, STEVEN BRIAN (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRIAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W. ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:918-455-2001
Mailing Address - Fax:918-301-0088
Practice Address - Street 1:5711 E 71ST ST SUITE 115
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6628
Practice Address - Country:US
Practice Address - Phone:918-494-2955
Practice Address - Fax:918-494-2905
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK186213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK620980735OtherGROUP PTAN
OK731510851OtherTAX ID
OKU43817Medicare UPIN