Provider Demographics
NPI:1922001379
Name:SMITH, CINDY L (LO, LPED)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LO, LPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 S WESTERN AVE
Mailing Address - Street 2:STE I
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2546
Mailing Address - Country:US
Mailing Address - Phone:405-366-0184
Mailing Address - Fax:405-604-6818
Practice Address - Street 1:8121 S WESTERN AVE
Practice Address - Street 2:STE I
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2546
Practice Address - Country:US
Practice Address - Phone:405-366-0184
Practice Address - Fax:405-604-6818
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLO 20, L.PED 27174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1255990001Medicare ID - Type Unspecified