Provider Demographics
NPI:1598186934
Name:SMITH, RYAN CHRISTOPHER (HIS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:SMITH
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W WILLOW RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2530
Mailing Address - Country:US
Mailing Address - Phone:580-237-0924
Mailing Address - Fax:
Practice Address - Street 1:1202 W WILLOW RD
Practice Address - Street 2:SUITE K
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2530
Practice Address - Country:US
Practice Address - Phone:580-237-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1070237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist