Provider Demographics
NPI:1114088283
Name:SIMMONS, SAM (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAMPUS BOX 7580
Mailing Address - Street 2:OCME
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CAMPUS BOX 7580
Practice Address - Street 2:OCME
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7580
Practice Address - Country:US
Practice Address - Phone:919-966-2253
Practice Address - Fax:919-962-6263
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40925207ZF0201X
NC2009-00245207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology