Provider Demographics
NPI:1710900097
Name:STEVEN A. SMITH, M.D., DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:STEVEN A. SMITH, M.D., DERMATOLOGY, P.C.
Other - Org Name:SMITH DERMATOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:918-664-9881
Mailing Address - Street 1:PO BOX 470324
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74147-0324
Mailing Address - Country:US
Mailing Address - Phone:918-664-9881
Mailing Address - Fax:
Practice Address - Street 1:9940 E 81ST STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4501
Practice Address - Country:US
Practice Address - Phone:918-664-9881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15063207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D42837Medicare UPIN
OK900522165Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER