Provider Demographics
NPI:1174610315
Name:METRO TULSA FOOT & ANKLE SPECIALIST PLLC
Entity type:Organization
Organization Name:METRO TULSA FOOT & ANKLE SPECIALIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-494-2902
Mailing Address - Street 1:5711 E 71ST ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6628
Mailing Address - Country:US
Mailing Address - Phone:918-494-2902
Mailing Address - Fax:918-494-2905
Practice Address - Street 1:5711 E 71ST ST
Practice Address - Street 2:SUITE 115
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6628
Practice Address - Country:US
Practice Address - Phone:918-494-2902
Practice Address - Fax:918-494-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK186213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100685820CMedicaid
OK100685820CMedicaid