Healthcare Provider Details

I. General information

NPI: 1639603137
Provider Name (Legal Business Name): SIMONE BIGELOW D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S SAINT LOUIS AVE
TULSA OK
74120-5440
US

IV. Provider business mailing address

1111 S SAINT LOUIS AVE
TULSA OK
74120-5440
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4400
  • Fax: 918-619-4696
Mailing address:
  • Phone: 918-619-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6364
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: