Glenn L Smith, D.O.

Primary specialty

SpecialistTaxonomy code 174400000X

License

1667 Issued in OK

Practice address

2149 SW 59TH St
Suite 101
Oklahoma City, OK 73119-7033

Phone

(405) 682-4651

Fax

(405) 682-3391

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southwest Family Clinic

  • Neuromusculoskeletal Medicine & OMM Physician
  • Oklahoma City, OK
  • NPI 1114236759
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279843200000",
    "number": "1740209170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 SW 59TH ST",
            "address_2": "SUITE 101",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731197033",
            "telephone_number": "405-682-4651",
            "fax_number": "405-682-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2149 SW 59TH ST",
            "address_2": "SUITE 101",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731197033",
            "telephone_number": "405-682-4651",
            "fax_number": "405-682-3391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GLENN",
        "middle_name": "L",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2010-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OK",
            "license": "1667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID #",
            "identifier": "731079803",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "731079803001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Falisha Smith
• Floyd Lee Smith, M.D.
• Gary Austin Smith, BHRS
• George Keith Smith, MD
• Ginger Smith
• Haley M Smith, LPC
• Hannah Smith
• Hannah Smith, MOT, OTR/L
• Hannah Smith
• Hannah Noel Smith

• Specialist in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.