Healthcare Provider Details

I. General information

NPI: 1124570817
Provider Name (Legal Business Name): ESTEFANIA TERON COSME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JIMMY EVEREST CENTER FOR CANCER AND BLOOD DISORDERS 1200 CHILDRENS AVENUE
OKLAHOMA CITY OH
73104
US

IV. Provider business mailing address

1200 CHILDRENS AVE STE 10A
OKLAHOMA CITY OK
73104-4637
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3741
  • Fax:
Mailing address:
  • Phone: 405-271-4412
  • Fax: 405-271-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21433
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number21433
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21433
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number41903
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: