Provider Demographics
NPI:1306575642
Name:SMITH, SAMUEL JAMES
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 E 43RD PL S
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5893
Mailing Address - Country:US
Mailing Address - Phone:918-860-1462
Mailing Address - Fax:
Practice Address - Street 1:13333 E 43RD PL S
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-5893
Practice Address - Country:US
Practice Address - Phone:918-860-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist