Provider Demographics
NPI:1336703123
Name:SIMER, SONI (PA)
Entity Type:Individual
Prefix:
First Name:SONI
Middle Name:
Last Name:SIMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SANOBER
Other - Middle Name:
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11601 KINGSWICK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2918
Mailing Address - Country:US
Mailing Address - Phone:817-902-7861
Mailing Address - Fax:
Practice Address - Street 1:11601 KINGSWICK DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2918
Practice Address - Country:US
Practice Address - Phone:817-902-7861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant