MEDICARE: NEVINSON PRADEEP SAM D.O.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	6588	OK
2	207L00000X	Anesthesiology Physician	6588	OK

General Provider Information

NPI Number	:	1497169213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEVINSON PRADEEP SAM D.O.

Provider Business Mailing Address
First Line	:	10001 S WESTERN AVE STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2993
Country	:	US
Telephone Number	:	405-286-2725
Fax Number	:	405-286-2724

Provider Business Practice Location Address
First Line	:	10001 S WESTERN AVE STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2993
Country	:	US
Telephone Number	:	405-286-2725
Fax Number	:	405-286-2724

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

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	01/06/2026

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