Individual
DR. COURTLAND PRENTICE SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26300 SOUTH HWY 125, AFTON, OK 74331
(918) 257-8585
(918) 257-8560
Mailing address
26300 SOUTH HWY 125, AFTON, OK 74331
(918) 257-8585
(918) 257-8560
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
107833
MO
207Y00000X
Otolaryngology Physician
Primary
25369
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128329001
—
AR
01
—
19859
BLUE CROSS BLUE SHIELD
MO
05
—
207948209
—
MO
01
—
97588
BLUE CROSS BLUE SHIELD
AR
Enumeration date
12/13/2006
Last updated
01/05/2009
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