Provider Demographics
NPI:1154476687
Name:EVERING-SIMMS, DIANE A (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:A
Last Name:EVERING-SIMMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-7338
Mailing Address - Country:US
Mailing Address - Phone:432-447-0565
Mailing Address - Fax:432-447-0422
Practice Address - Street 1:200 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772-6607
Practice Address - Country:US
Practice Address - Phone:432-447-0565
Practice Address - Fax:432-447-0422
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5317207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099318005Medicaid
TX099318005Medicaid
TX00H020EMedicare PIN