Healthcare Provider Details

I. General information

NPI: 1689179715
Provider Name (Legal Business Name): TOMMIE SIMON MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 SW LEE BLVD
LAWTON OK
73505-9678
US

IV. Provider business mailing address

6401 SW LEE BLVD
LAWTON OK
73505-9678
US

V. Phone/Fax

Practice location:
  • Phone: 580-699-5139
  • Fax:
Mailing address:
  • Phone: 580-699-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: TOMMIE SIMON
Title or Position: SOLE MEMBER/OWNER
Credential: MD
Phone: 832-248-4062