Individual
AUSTIN SMITH IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 NE 13TH ST, OKLAHOMA CITY, OK 73104-5004
(316) 259-2495
Mailing address
1812 RR Y, DONIPHAN, MO 63935
(573) 429-7973
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2024032187
MO
207R00000X
Internal Medicine Physician
Primary
43359
OK
207R00000X
Internal Medicine Physician
A184013
CA
207R00000X
Internal Medicine Physician
V1494
TX
208M00000X
Hospitalist Physician
43359
OK
Other
Enumeration date
04/21/2021
Last updated
11/07/2024
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