MEDICARE: LEE HALVOR SIMPSON PA-C

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	363A00000X	Physician Assistant	PA1630	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1630	OTHER	OK	PA LICENSE

General Provider Information

NPI Number	:	1467677492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE HALVOR SIMPSON PA-C

Provider Business Mailing Address
First Line	:	2225 N UNION ST.
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1536
Country	:	US
Telephone Number	:	918-308-5515
Fax Number	:	580-749-5792

Provider Business Practice Location Address
First Line	:	2225 N UNION ST.
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1536
Country	:	US
Telephone Number	:	918-308-5515
Fax Number	:	580-749-5792

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	03/11/2021

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Directions to “ LEE HALVOR SIMPSON PA-C” Practice Location

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