Individual
MATTHEW SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
423 S 79TH EAST AVE, TULSA, OK 74112-2139
(918) 829-4076
Mailing address
423 S 79TH EAST AVE, TULSA, OK 74112-2139
(918) 829-4076
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/03/2024
Last updated
04/03/2024
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