Provider Demographics
NPI:1578769055
Name:SMITH, MARCUS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:JOHN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 QUAIL SPRINGS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2604
Mailing Address - Country:US
Mailing Address - Phone:405-701-9880
Mailing Address - Fax:405-701-9881
Practice Address - Street 1:3200 QUAIL SPRINGS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2604
Practice Address - Country:US
Practice Address - Phone:405-701-9880
Practice Address - Fax:405-701-9881
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25706207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200210130AMedicaid
OK352879YSGZMedicare PIN
OK200210130AMedicaid