Provider Demographics
NPI:1073568846
Name:SIMONS, CRAIG GLENN (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:GLENN
Last Name:SIMONS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 NE NIGHTSHADE AVE
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-8428
Mailing Address - Country:US
Mailing Address - Phone:816-525-0135
Mailing Address - Fax:816-525-1058
Practice Address - Street 1:2305 SOUTH 65 HIGHWAY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340
Practice Address - Country:US
Practice Address - Phone:660-886-7431
Practice Address - Fax:660-831-3314
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001019072208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO508993300Medicaid
MO245865902Medicaid
MO508993300Medicaid