Provider Demographics
NPI:1790822534
Name:SMITH, TWYLA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TWYLA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MCGEE DR STE 149
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6705
Mailing Address - Country:US
Mailing Address - Phone:405-321-1418
Mailing Address - Fax:405-321-0785
Practice Address - Street 1:2500 MCGEE DR STE 149
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6705
Practice Address - Country:US
Practice Address - Phone:405-321-1418
Practice Address - Fax:405-321-0785
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK149262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35290Medicare UPIN