Individual
TATUM SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1120 S AIR DEPOT BLVD, MIDWEST CITY, OK 73110-4861
(405) 427-2020
Mailing address
1120 S. AIR DEPOT BLVD., MIDWEST CITY, OK 73110-1213
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528306156
—
OK
Enumeration date
01/16/2013
Last updated
09/04/2014
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