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General NPI Number Information
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NPI Number | 1518307529
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Entity Type | Organization
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Legal Business Name | TEXOMA PEDIATRICS, PLLC
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 430 BRYAN DR
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City | DURANT
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State | OK
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Zip | 74701-3467
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Country | US
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Telephone | 580-920-1980
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Fax | 580-920-9937
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Provider Business Mailing Address
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Address Line | PO BOX 128
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City | DURANT
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State | OK
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Zip | 74702-0128
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Country | US
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Telephone | 580-920-1980
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Fax | 580-920-9937
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL SIMULESCU
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Credential | D.O.
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Telephone | 580-920-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4154
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License Number State | OK
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