=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588688196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JASON B. SIGMON, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 04/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10960 N MAY AVE
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120-6202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-595-3575
-----------------------------------------------------
Fax | 405-607-3550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10960 N MAY AVE
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120-6202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-595-3575
-----------------------------------------------------
Fax | 405-607-3550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PHYSICIAN
-----------------------------------------------------
Name | DR. JASON BRANDT SIGMON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 405-945-4819
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 22691
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------