Provider Demographics
NPI:1083667737
Name:JAGGERNAUTH, SIMEON (DO)
Entity type:Individual
Prefix:
First Name:SIMEON
Middle Name:
Last Name:JAGGERNAUTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11212 E 48TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5824
Practice Address - Country:US
Practice Address - Phone:918-556-3000
Practice Address - Fax:918-556-7052
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3898207RX0202X
ARE9890207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH94210Medicare UPIN