Organization
MALCOLM DEREK SMITH, DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RAE SMITH (OFFICE MANAGER)
(580) 765-3389
Entity
Organization
Contact information
Practice address
1700 N 5TH ST, PONCA CITY, OK 74601-2762
(580) 765-3389
(580) 762-3994
Mailing address
1700 N 5TH ST, PONCA CITY, OK 74601-2762
(580) 765-3389
(580) 762-3994
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
198
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100779800A
—
OK
01
—
294540038001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
02/26/2008
Last updated
02/26/2008
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