MEDICARE: MS. JUMOK K BOTTOMS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	1110	OK
2	363A00000X	Physician Assistant	1110	OK

General Provider Information

NPI Number	:	1124049481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUMOK K BOTTOMS PA

Provider Business Mailing Address
First Line	:	4303 PITMAN ST
Second Line	:
City	:	FORT SILL
State	:	OK
Zip	:	73503-4473
Country	:	US
Telephone Number	:	580-483-3643
Fax Number	:	580-483-3643

Provider Business Practice Location Address
First Line	:	4303 PITMAN & THOMAS RD
Second Line	:
City	:	FT SILL
State	:	OK
Zip	:	73503
Country	:	US
Telephone Number	:	580-215-8494
Fax Number	:	405-456-7572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	06/10/2021

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