Provider Demographics
NPI:1225835465
Name:SMITH, MARCUS LEE SR
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:LEE
Last Name:SMITH
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3120 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-6267
Mailing Address - Country:US
Mailing Address - Phone:405-326-0248
Mailing Address - Fax:
Practice Address - Street 1:3120 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-6267
Practice Address - Country:US
Practice Address - Phone:405-326-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator