Provider Demographics
NPI:1780638502
Name:ALLERGY EAR NOSE AND THROAT INSTITUTE PLLC
Entity Type:Organization
Organization Name:ALLERGY EAR NOSE AND THROAT INSTITUTE PLLC
Other - Org Name:SOUTHWEST OKLAHOMA EAR NOSE AND THROAT SPECIALISTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-536-8844
Mailing Address - Street 1:4920 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8339
Mailing Address - Country:US
Mailing Address - Phone:580-536-8844
Mailing Address - Fax:580-536-8818
Practice Address - Street 1:4920 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8339
Practice Address - Country:US
Practice Address - Phone:580-536-8844
Practice Address - Fax:580-536-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522369Medicare PIN