Provider Demographics
NPI:1902866825
Name:SIMMONS, TERRILL H (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRILL
Middle Name:H
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4802 S 109TH E AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146
Mailing Address - Country:US
Mailing Address - Phone:918-392-1400
Mailing Address - Fax:918-392-1488
Practice Address - Street 1:12455 E 100TH ST N
Practice Address - Street 2:SUITE 260
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4674
Practice Address - Country:US
Practice Address - Phone:918-272-9464
Practice Address - Fax:918-274-5569
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK9335207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731001289002OtherBLUE SHIELD OF OKLAHOMA
OK731001289002OtherBLUE SHIELD OF OKLAHOMA