IndividualActive
Brian Smith, PRESIDENT
NPI 1114118643 · Specialist · Oklahoma City, OK
Provider details
- NPI number
- 1114118643
- Entity type
- Individual
- Primary specialty
- SpecialistOther Service Providers
- Credential
- PRESIDENT
- Sex
- Male
- Sole proprietor
- Yes
- License
- 24186 (OK)
Practice location
6718 S Western Ave
Oklahoma City, OK 73139-1807
Phone: (405) 602-1053
Fax: (405) 602-1059
Mailing address
6718 S Western Ave
Oklahoma City, OK 73139-1807
Registry dates
- Enumerated
- 2007-08-08
- Last updated
- 2007-08-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.