Healthcare Provider Details

I. General information

NPI: 1821611419
Provider Name (Legal Business Name): NICHOLAS REEDE HOFFSOMMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

405 S OKLAHOMA AVE
CHEROKEE OK
73728-2545
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4700
  • Fax:
Mailing address:
  • Phone: 580-596-2800
  • Fax: 580-596-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7343
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: