Individual
JACK BRADLEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4401 W MEMORIAL RD, OKLAHOMA CITY, OK 73134-1785
(405) 751-4664
(405) 749-4561
Mailing address
18432 WILD HORSE TRL, NORMAN, OK 73072-9603
(405) 760-0560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1155
OK
Other
Enumeration date
03/14/2006
Last updated
12/01/2025
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