Provider Demographics
NPI:1477524023
Name:CONWAY, JIMMY H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:H
Last Name:CONWAY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10001 S WESTERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2997
Mailing Address - Country:US
Mailing Address - Phone:405-692-3700
Mailing Address - Fax:405-692-3789
Practice Address - Street 1:10001 S WESTERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2997
Practice Address - Country:US
Practice Address - Phone:405-692-3700
Practice Address - Fax:405-692-3789
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK16834207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC14714Medicare UPIN
OK200028313OtherRAILROAD MEDICARE
OK100106750AMedicaid