Provider Demographics
NPI:1316901838
Name:SMITH, STEWART C (MD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-552-0401
Mailing Address - Fax:405-848-3210
Practice Address - Street 1:3366 NW EXPRESSWAY STE 250
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4427
Practice Address - Country:US
Practice Address - Phone:405-552-0401
Practice Address - Fax:405-848-3210
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15335207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100136140AMedicaid
OK$$$$$$$$$005OtherBCBS
5390430014Medicare NSC
OK100136140AMedicaid
5390430002Medicare NSC
OKP00334694Medicare PIN
OKE81368Medicare UPIN