Provider Demographics
NPI:1225060346
Name:SIMMONS, BYRON H (MD)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:H
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 HAZELWOOD ST STE 310
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1241
Mailing Address - Country:US
Mailing Address - Phone:651-264-1500
Mailing Address - Fax:651-264-1646
Practice Address - Street 1:2945 HAZELWOOD ST STE 310
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1241
Practice Address - Country:US
Practice Address - Phone:651-264-1500
Practice Address - Fax:651-264-1646
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48318207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN099565700Medicaid
MN386950400Medicaid
MN191813300Medicaid