Individual
GLENN L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2149 SW 59TH ST, SUITE 101, OKLAHOMA CITY, OK 73119-7033
(405) 682-4651
(405) 682-3391
Mailing address
2149 SW 59TH ST, SUITE 101, OKLAHOMA CITY, OK 73119-7033
(405) 682-4651
(405) 682-3391
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1667
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
731079803
FEDERAL TAX ID #
OK
01
—
731079803001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
07/18/2006
Last updated
07/23/2010
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