Provider Demographics
NPI:1003827080
Name:SIMMONS, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:SIMMONS
Suffix:
Gender:M
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:PO BOX 1886
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1886
Mailing Address - Country:US
Mailing Address - Phone:308-630-1400
Mailing Address - Fax:308-632-7830
Practice Address - Street 1:4021 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4602
Practice Address - Country:US
Practice Address - Phone:308-630-1400
Practice Address - Fax:308-632-7830
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18303207ZP0102X
SD4983207ZP0102X
WY5935A207ZP0102X
CO25521207ZP0102X
CAG54216207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4983OtherDAKOTACARE
SD7706270Medicaid
2714OtherBCBS (CLASSIC AND PREFERR
WY10453118 00Medicaid
SD7706270Medicaid
NE090114Medicare PIN