Provider Demographics
NPI:1649460197
Name:SIMS, JASON WARNER (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WARNER
Last Name:SIMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 S HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9120
Mailing Address - Country:US
Mailing Address - Phone:918-551-7010
Mailing Address - Fax:918-358-3321
Practice Address - Street 1:1401 W PAWNEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-3033
Practice Address - Country:US
Practice Address - Phone:918-358-2501
Practice Address - Fax:918-358-3321
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200133820AMedicaid