Healthcare Provider Details

I. General information

NPI: 1427338490
Provider Name (Legal Business Name): JR SIMONSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 NW 63RD ST STE 100
OKLAHOMA CITY OK
73116-1937
US

IV. Provider business mailing address

13919B N MAY AVE # 212
OKLAHOMA CITY OK
73134-5035
US

V. Phone/Fax

Practice location:
  • Phone: 405-696-8201
  • Fax: 903-787-5854
Mailing address:
  • Phone: 888-991-1101
  • Fax: 903-787-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES R SIMONSON
Title or Position: OWNER
Credential: MD
Phone: 405-696-8201