Individual
LONNIE V. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4300 W MEMORIAL RD, ER DEPT., OKLAHOMA CITY, OK 73120-8304
(405) 752-3715
(405) 936-5058
Mailing address
2115 PARKVIEW DR, EL RENO, OK 73036-2109
(405) 295-1166
(405) 295-1334
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
698
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100117880A
—
OK
05
—
100117880B
—
OK
Enumeration date
04/04/2006
Last updated
03/25/2015
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