Provider Demographics
NPI:1124570817
Name:TERON COSME, ESTEFANIA (MD)
Entity type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:
Last Name:TERON COSME
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CHILDRENS AVE STE 10A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-271-4412
Mailing Address - Fax:405-271-3265
Practice Address - Street 1:JIMMY EVEREST CENTER FOR CANCER AND BLOOD DISORDERS
Practice Address - Street 2:1200 CHILDRENS AVENUE
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OH
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21433208000000X, 2080P0207X, 208D00000X
OK419032080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice