Provider Demographics
NPI:1104355114
Name:SMITH, SARAH ELISE (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ELISE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:941 W I 35 FRONTAGE RD STE 116
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7375
Mailing Address - Country:US
Mailing Address - Phone:405-359-5370
Mailing Address - Fax:
Practice Address - Street 1:3500 NW 56TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4517
Practice Address - Country:US
Practice Address - Phone:405-951-2855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine