Individual
TINA C SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5109 W GORE BLVD, LAWTON, OK 73505-5998
(580) 699-2495
(580) 699-2515
Mailing address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 558-8497
(580) 429-0819
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
24054
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200038730A
—
OK
01
—
487023200
DOL
OK
01
—
7664685
AETNA
OK
01
—
P00166228
RAILROAD MEDICARE
—
Enumeration date
09/20/2005
Last updated
04/18/2026
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