Provider Demographics
NPI:1366437246
Name:SMITHTON, CORBY WADE (DO)
Entity type:Individual
Prefix:DR
First Name:CORBY
Middle Name:WADE
Last Name:SMITHTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1921 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4204
Mailing Address - Country:US
Mailing Address - Phone:405-533-1474
Mailing Address - Fax:405-742-4990
Practice Address - Street 1:1921 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4204
Practice Address - Country:US
Practice Address - Phone:405-533-1474
Practice Address - Fax:405-742-4990
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100119580AMedicaid
OK100119580AMedicaid
OKH67046Medicare UPIN