=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447259171
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES A SIMON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2005
-----------------------------------------------------
Last Update Date | 06/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6585 S YALE AVE STE 720
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-8320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-502-5930
-----------------------------------------------------
Fax | 918-502-5935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6600 S YALE AVE STE 1400
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-247-0125
-----------------------------------------------------
Fax | 918-502-8001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 38704
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------