Provider Demographics
NPI:1235116385
Name:SIMMS, JERRY D (DPM)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:D
Last Name:SIMMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-6002
Mailing Address - Country:US
Mailing Address - Phone:215-752-1881
Mailing Address - Fax:215-752-6907
Practice Address - Street 1:2404 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-6002
Practice Address - Country:US
Practice Address - Phone:215-752-1881
Practice Address - Fax:215-752-6907
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001724L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1403260Medicaid
SI131423Medicare ID - Type Unspecified
PA1403260Medicaid